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Antidepressants and Pregnancy OK?

But Certain SSRIs May Boost Specific Birth Defect Risks, New Studies Show
By
WebMD Health News
Reviewed by Louise Chang, MD

June 27, 2007--Taking antidepressants during pregnancy doesn't greatly increase the overall risk of most birth defects, new research shows.

But taking specific antidepressants may slightly increase the risk of certain birth abnormalities, the researchers say.

The two new studies, published in the June 28 issue of The New England Journal of Medicine, examined a type of popular antidepressants called SSRIs, or selective serotonin reuptake inhibitors. The drugs work by making more of the brain chemical serotonin available to the brain, thought to help in boosting mood.

While the results from the two studies are at odds on some points, they are in agreement on others. Paxil, for instance, was found to be strongly associated with specific defects. And the risks of certain birth defects, while increased, are still very small, the researchers say.

Concerns about birth defects associated with SSRI use began to surface three years ago, says Carol Louik, ScD, assistant professor of epidemiology at Boston University, Boston, and an author of one study. But research on SSRI use during pregnancy has produced mixed findings.

"There have been several studies in the past that have found an association between several SSRIs and certain birth defects, such as heart defects," says Jennita Reefhuis, PhD, an epidemiologist with the National Center on Birth Defects and Developmental Disabilities for the CDC, and a co-author of the other new study.

In 2005, the FDA alerted doctors and patients that the SSRI Paxil had been found to increase the risk of birth defects, especially heart defects, when it was taken during the first three months of pregnancy.

The new studies don't answer the question about the safety of SSRI use during pregnancy definitively, but they do add valuable information for women trying to decide. Both studies should reassure women, Louik and Reefhuis say.

CDC Study Details

Reefhuis' team evaluated data from 9,622 infants born with major birth defects and 4,092 infants born without birth defects, all delivered during the years 1997-2002. The data was obtained through the CDC-funded National Birth Defects Prevention Study, an ongoing effort that collects information from eight states.

The mothers participated in a telephone interview, answering questions about their exposure to antidepressants during pregnancy and one month before. In all, 3% of them, or 408, reported use of SSRIs during pregnancy or one month before they conceived.

The researchers evaluated four SSRIs, including Prozac, Zoloft, Paxil, and Celexa. Overall, no significant associations were found between the mother's use of the SSRIs and congenital heart defects, Reefhuis says. But they did find that Paxil use was linked to one type of heart defect, called right ventricular outflow tract obstruction defect, she says.

And they found an overall association between SSRIs and three other types of birth defects:

  • Anencephaly. A defect in which the neural tube fails to close. The neural tube is a narrow channel that normally closes about the fourth week of pregnancy to form the brain and spinal cord.
  • Craniosynostosis. A defect in which the joints between the bones of the skull close prematurely before brain growth is complete. Mental retardation can occur.
  • Omphalocele. An abdominal wall defect in which intestines and other organs can protrude.

The increased risk ranged from 2.4 to 2.8 times higher, she says. But the numbers of infants affected, in each case, were small, she says. For instance, nine of the 214 born with anencephaly were exposed to SSRIs.

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