More Information to Enlighten and Confuse Us Regarding Meds and Pregnancy

As reported in the New York Times: Two new studies reported in The New England Journal of Medicine, provide further reassurance that antidepressants are not a major cause of serious physical complications in newborns. They report that taking an SSRI antidepressant during pregnancy may increase the risk of birth defects, but the chances appear to be remote and limited to a few rare birth defects.

“In both studies, researchers interviewed mothers of more than 9,500 infants with birth defects, including cleft palate and heart valve problems. They found that mothers who remembered being on antidepressants like Zoloft, Paxil or Prozac while pregnant were at no higher risk for most defects than a control group of women who said they had not taken antidepressants.”

As reviewed in “Overall, SSRI use was not associated with significantly increased risks of craniosynostosis (when connections between skull bones close prematurely), omphalocele (when intestines or other abdominal organs protrude from the navel) or heart defects. There were, however, associations between maternal use of Zoloft (sertraline) and omphalocele and septal defects (defects in the walls that separate the chambers of the heart) and between Paxil and defects that interfere with blood flow to the lungs. But even if a certain drug increased rates by a factor of four, the risk of having a child affected by the problem would still be less than 1 percent, the researchers said.”

There were associations between SSRI use during pregnancy and anencephaly (a brain defect), craniosynostosis and omphalocele, but, again, the absolute risk was very small. According to the authors of the study: These defects had not previously been associated with SSRI use during pregnancy.

The article (NEJM) points out some limitations of the study:

1) did not include enough cases to adequately assess risk of many rare defects.

2) did not include information on how long women were taking antidepressants.

3) did not include information on the dosage of the medication.

4) did not evaluate behavioral effects (noting that previous work has linked withdrawal from antidepressants and its possible link to further behavioral problems)

These studies found a small increase in the absolute risk of some rare birth defects but the overall risk was very small.

Once again, this reminds us that we must all be prudent when prescribing meds during pregnancy.

For more info on depression and treatment during pregnancy:

OTIS (Organization of Teratology Information Specialists)

HRSA (US Department of Health and Human Services)

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