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Antidepressants in Pregnancy and Baby's Heart

But, past research shows risks, and one expert says this study doesn't provide definitive answers

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But one expert does not find the results of the study reassuring. "While this is an excellent group of researchers, there are some serious flaws with this study," said Dr. Adam Urato, maternal-fetal medicine specialist at Tufts Medical Center, in Boston.

"This isn't rocket science. We know that exposing developing babies to synthetic chemicals is almost always a really bad idea and should be avoided whenever possible," said Urato. "This study does nothing to alter that common sense conclusion."

Urato said there were several specific problems with the study. Analysis of the huge database was likely to have misclassified whether women were indeed taking their antidepressants (not just picking up the prescription), which would make the medications look safer than they actually are, he explained.

The study didn't identify miscarriages, which are linked to antidepressants. "It may be that the most severely affected pregnancies are miscarrying," Urato said.

And he questioned why evidence of smoking and weight issues weren't considered in the data analysis. "We know that smoking is common in a Medicaid population and that it's associated with heart defects," Urato said, "and body mass index [a measurement based on height and weight] may also influence this."

Urato added that because current research suggests that antidepressant use -- especially SSRIs like Paxil and Zoloft -- is associated with increased risk of miscarriage, birth defects, preterm birth, early rupture of membranes, preeclampsia (high blood pressure associated with pregnancy), and neurological problems in newborns, among other issues, pregnant women should not take them.

As for a potential risk of suicide in a woman who is pregnant and seriously depressed, Urato said the evidence still suggests antidepressants are an unsafe option. "The evidence is that antidepressant use is associated with suicide in young people who take those medications," he said.

So, where does that leave a depressed woman who is pregnant?

"The best available current evidence strongly suggests that for most women, nondrug approaches to mental health issues such as psychotherapy and exercise provides as much -- or more -- benefit than chemical antidepressants," said Urato. These nondrug therapies should be tried first in women who are pregnant or of childbearing age, he added.

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