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Antidepressants Pose Small Risk in Pregnancy
> 6/28/2007 11:06:38 AM

Two new studies appearing in the New England Journal of Medicine address the topic of birth defects as a result of SSRI use during pregnancy. In many ways, these new reports echo worries about antidepressant use for expectant mothers which were first voiced 18 months ago. It was in December of 2005 that the FDA released information regarding heart defect risks with the use of Paxil during pregnancy. That spawned a wide-ranging debate about the use of depression drugs for pregnant women. The headlines this time around may be more muted, but will likely spur similar discussion.

In the first of these new studies, researchers from the University of British Columbia used data on over 9,000 children born with birth defects as a jumping off point to interview mothers about a host of potential risk factors. When compared against a control group, the team found no significant link between maternal SSRI use and heart defects, but did find small, potential links to other rare defects. In the second study, researchers from Boston University used data from the Slone Epidemiology Center's Birth Defects Study to examine the effects of first-trimester maternal SSRI usage and birth defects. By looking at over 15,000 total births, they concluded again that the risks associated with SSRIs were for specific types of defects that were rare and had small absolute numbers.

While both reports made sure to point out that further research will be necessary before anything can be said with authority, taken together these studies point to a small but statistically significant group of children displaying defects after SSRI use during pregnancy. Dr. William Hapworth addressed this topic after the FDA's announcement about Paxil, and at that time discussed his own approach to treating women who were pregnant or who were considering getting pregnant:

The safety of the fetus is paramount and patients desiring to become pregnant would be wise to slowly decrease their psychiatric drugs before attempting to get pregnant. Coming off medication has to be a strategic part of planning for having a child and physicians need to be fully involved in this process. I will also ask a female patient of child bearing age if they intend to become pregnant and if they do I have a lengthy discussion about how we need to work together on a pregnancy plan that doesn�t include psychotropic drugs. These are critical discussions that physicians/psychiatrists must have with their female patients.

As Dr. Hapworth also pointed out at the time, there is no way to run any sort of double-blind, placebo study that would shed greater light on all the potential factors that come into play with maternal SSRI usage. Even though the evidence from these two new studies remains paltry, mothers would do well to remain on the safe side by avoiding SSRI usage. Dr. Hapworth mentions that this is a contingency that women using antidepressants must discuss with their therapist or psychiatrist. Depression and other mental health disorders can have negative impacts on a pregnancy, but with the help of a mental health professional, mothers-to-be can explore a range of options that will allow them to proceed with their preganancy in a way that protects the fetus from any potential harm.

Comments
I had this same discussion with both my OB/GYN and my psychiatrist when I became pregnant while on Paxil. The decision for me to continue taking Paxil was based on known risks vs. unknown risks. My son is now 4 years old and has had no known adverse side effects or developmental issues.
URL: http://ocdonastick.blogspot.com/
Posted by: OCD On A Stick 6/30/2007 3:01:50 AM