“[Selective serotonin reuptake inhibitors] are increasingly used by women of reproductive age and during pregnancy, but the inconsistent reports have limited opportunities for clinicians to carefully evaluate the risk compared with benefit of specific [selective serotonin reuptake inhibitors] for a given patient during pregnancy”, study researcher Jennita Reefhuis, PhD, of the CDC’s National Center for Birth Defects and Developmental Disabilities, and colleagues wrote in BMJ.
The study looked at the number of birth defects among the babies, and asked mothers if they were taking any antidepressants during the month before or first three months of their pregnancies.
Basing their analysis on 17,952 mothers of infants with birth defects and 9,857 mothers of infants without birth defects, born between 1997 and 2009, the researchers note that they have observed an association between previously reported birth defects and few SSRIs.
For almost a decade now, we’ve known about the potential association between paroxetine, a member of this drug class, and a slightly increased risk of minor heart defects in children when mothers in first trimester use this drug.
Therefore, according to the study published in BMJ, the use of a few antidepressants might increase the risks of birth defects, while others may not pose such a high risk, after all.
For women taking Paxil, the risk of giving birth to a child with anencephaly rose from 2 in 10,000 to 7 in 10,000; the risk of giving birth to a child with a heart blood flow problem rose from 10 in 10,000 to 24 in 10,000, the study found.
But the study didn’t prove that the medications cause birth defects, and experts aren’t advising women to stop taking the drugs entirely. The researchers could not say whether or not the antidepressants are the direct cause of the birth defects, only that there is a few connection between the two, but not a big enough one to pose a significant risk.
Researchers say more research is needed to help women and doctors to make more informed decisions about treatment.
“Depression can be very serious, and women should not suddenly stop taking their medications”.
The debate over whether or not it’s safe to take antidepressants during pregnancy is heated, with extreme emotions – and conflicting research studies – on both sides.
“The overall risk is still small”, Jenna Reefhuis, an epidemiologist and lead researcher in the study, told NPR.
The Food and Drug Administration issued a warning in 20005 that the risk for birth defects, and heart defects in particular, could be increased by Paxil.
“Continued scrutiny of the association between SSRIs and birth defects is warranted”
Fluoxetine was linked to right ventricular outflow tract obstruction defect and craniosynostosis (one or more of the joints between the bones of a baby’s skull fuse before the brain is fully formed).
But the analysis did find an association between birth defects and the antidepressants fluoxetine (Prozac) or paroxetine (Paxil). This is reassuring, said the study authors, as about 40% of women reporting use of an SSRI in early pregnancy used sertraline. There’s none of them that suggests that these are really dangerous drugs.