Paroxetine Cardiac Risk — MRCPsych Paper B MCQ

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ModeratePerinatal PsychiatryParoxetine Cardiac RiskMRCPsych Paper B

A pregnant woman has taken paroxetine 30 mg daily throughout the first trimester. Which congenital anomaly has been specifically associated with first-trimester paroxetine exposure?

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Correct answer: A — Atrial or ventricular septal defect

Explanation lettering: C = shown as A · A = shown as B · B = shown as C · E = shown as D · D = shown as E

C is correct. Epidemiological data and the UK SmPC associate first-trimester paroxetine exposure with a small increase in congenital cardiovascular malformations, particularly atrial and ventricular septal defects. The SmPC estimates a cardiovascular-defect risk of less than 2 per 100 exposed pregnancies, compared with approximately 1 per 100 in the general population. This is an association rather than proof of causation, and counselling should balance fetal risk against maternal relapse and avoid abrupt discontinuation. Neural tube defects are more characteristically associated with valproate and carbamazepine. Ebstein anomaly is historically associated with first-trimester lithium exposure. Limb reduction defects are classically associated with thalidomide, while renal agenesis is not a characteristic paroxetine-associated malformation.

Reference: electronic Medicines Compendium. Paroxetine 20 mg Tablets: Summary of Product Characteristics, section 4.6, Fertility, pregnancy and lactation. Current SmPC accessed 19 August 2026. https://www.medicines.org.uk/emc/product/537/smpc