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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 most credible."

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 Paxil.

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, Reefhuis says.

"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 says.

"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 monitored.

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