Longitudinal metabolic profiling of women using selective serotonin reuptake inhibitors during pregnancy

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Paper Summary

Conflicts of Interest

Identified Weaknesses

Rating Explanation

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Paper Summary

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SSRIs and Pregnancy: A Lipid Story (But Don't Worry Too Much)

In this observational study of pregnant women, SSRI use was associated with small alterations in lipid metabolism, mainly impacting lipoprotein composition. While statistically significant, the changes were minor compared to normal pregnancy fluctuations and their clinical relevance is uncertain. More research is needed to understand the link between SSRI use during pregnancy and fetal development.

Possible Conflicts of Interest

One author (O.K.) is a co-founder of Afekta Technologies Ltd., a company that provides metabolomics analysis services, but declares that these were not used in the study.

Identified Weaknesses

Observational study design

Reliance on observational data makes determining causality impossible. It's impossible to determine if the observed metabolic changes are due to SSRI use or other factors related to depression itself. Confounding variables (depression severity, lifestyle factors, etc.) could influence both SSRI use and lipid metabolism.

Partial loss to follow-up

While the study had a decent sample size, there was loss-to-follow-up with some participants only having data from one trimester. This can introduce bias and impact the robustness of the longitudinal analyses.

Indirect measurement of SSRI usage

Relying on medical records and self-reported data, rather than directly measuring serum SSRI levels introduces potential for misclassification of SSRI use or incorrect dosage information, leading to inaccurate assessments of the relationship between SSRIs and metabolic profiles.

Limited sample matching between timepoints

Limited matching samples in the first trimester and delivery for the SSRI group hindered comparisons of the magnitude of SSRIs' effects on metabolic measures between the timepoints.

Lack of control for potential confounders

The study did not account for maternal diet, genetics, or microbiome. These factors can significantly influence both lipid metabolism and mental health, potentially confounding the association between SSRIs and observed metabolic changes.

Rating Explanation

This is a generally well-conducted study with a reasonably large sample size and a clear methodology. The use of NMR for metabolic profiling is a strength. However, the limitations inherent in the observational design, combined with lack of direct SSRI measurement, reduce the rating to 4.

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