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SSRIs in Pregnancy — MRCPsych Paper B MCQ

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ModeratePerinatal PsychiatrySSRIs in PregnancyMRCPsych Paper B

A 31-year-old woman with recurrent depression is taking paroxetine 40 mg daily and is planning a pregnancy. During a preconception review, the psychiatrist discusses the potential benefits and risks of continuing treatment or gradually changing medication. Which adverse outcome is associated with paroxetine exposure during the first trimester?

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Correct answer: A — Increased risk of congenital cardiac defects, including septal defects

Paroxetine exposure during the first trimester is associated with a small increased risk of congenital cardiovascular malformations, including ventricular and atrial septal defects. The current UK SmPC estimates the absolute risk at less than 2 in 100, compared with approximately 1 in 100 in the general population. Neural tube defects are classically associated with medicines such as valproate rather than paroxetine. Persistent pulmonary hypertension of the newborn and neonatal adaptation symptoms are principally concerns following SSRI exposure later in pregnancy. Postpartum haemorrhage is associated with SSRI or SNRI exposure close to delivery, not specifically with first-trimester exposure. Preconception decisions should be individualised according to previous response, relapse risk and patient preference; paroxetine should not be stopped abruptly.

Reference: Paroxetine 30 mg film-coated tablets, Summary of Product Characteristics, section 4.6 Fertility, pregnancy and lactation, revised 19 May 2026. https://www.medicines.org.uk/emc/product/539/smpc