Antidepressants and Pregnancy OK?
But Certain SSRIs May Boost Specific Birth Defect Risks, New Studies Show
Early Antidepressant Use Study
Louik and her team evaluated birth defects and SSRI use in the first
trimester of pregnancy in 9,849 infants with birth defects and 5,860
without, using data from the ongoing Slone Epidemiology Center's Birth Defects
Study. "The point was to evaluate specific SSRIs and specific birth
defects," she says. "What we found was although we didn't see an
increased risk overall for SSRIs, there were some individual SSRIs that
increase the risk for specific birth defects."
In contrast to the CDC study, her team did not find an association of a
significantly increased overall risk for craniosynostosis, omphalocele, neural
tube defects as a group, or overall heart defects. But they did find
specific drugs are linked to specific defects.
"Paxil was associated with the defects that affect blood flow to the
lung," she says. “Zoloft was associated with septal defects, the opening in
the wall that separates the chambers of the heart. Those are ones we think are
Zoloft was also found to be linked to omphalocele, but she considers that
association less credible. Only three of the 127 with this defect had been
exposed to Zoloft.
Her study was partially supported by GlaxoSmithKline, the maker of
Weighing the Benefits
Women should keep the risks of antidepressant use during pregnancy in
perspective and weigh the potential benefits of SSRI use with their physician,
"Any pregnancy carries a risk of about 3% of having a birth defect
regardless of exposures," she says.
The birth defects she found in her study to be linked to SSRI use are rare,
she says. Craniosynostosis, for instance, occurs in one in 2,500 births, she
"Even if you quadruple the risk [of the three birth defects she found
linked to SSRI use], there is still less than a 1% chance of having a child
with that specific defect," Reefhuis says.
Clinical depression affects about 8% to 20% of women, Louik says, and during
pregnancy, about 10% of women are affected. For some, antidepressants are the
best treatment, she says.
Caveats: Antidepressants During Pregnancy
Women and their doctors should weigh the potential risks in the context of
the risk of depression relapse during the pregnancy if the drugs are
discontinued and the depression worsens, according to the American College of
Obstetricians and Gynecologists.
In its committee opinion on SSRI use during pregnancy issued in December
2006, it recommends that treatment with SSRIs, if needed during pregnancy, be
individualized. Paxil, it advises, should be avoided if possible by pregnant
women and those planning to conceive.
Pregnant women shouldn't stop antidepressants abruptly, experts warn,
because doing so could worsen the depression.
"The best recommendation one can make is for anyone pregnant and on
these drugs to discuss it with their health care provider, usually their
obstetrician," says Michael Katz, MD, vice president for research for the
March of Dimes. He advises that a woman and her doctor decide together if it
would be best to discontinue the drugs or to say on them and be closely