Antidepressants during pregnancy and birth defects

The New England Journal of Medicine published today two research studies on the link between the use of antidepressants by the mother during pregnancy and the risk of the baby being born with birth defects.

Studies, conducted respectively by researchers from Boston University's Slone Epidemiology Center and the US Centers for Disease Control and Prevention (CDC), Atlanta, suggest that the use of anti-depressant drugs from the family of SSRI-s (selective serotonin reuptake inhibitors) during pregnancy did not increase the overall risk for birth defects significantly.

However, both studies also concluded that individual anti-depressants, taken during pregnancy, may increase the risk for specific birth defects, but that these birth defects are different and each one is rare and that the risks are small.

The SSRI anti-depressant drug family includes common and "famous" names like Celexa, Paxil, Prozac and Zoloft. The effect of their use during pregnancy on the babies and the risks of birth defects associated to this use have been the topic of many studies, but previous research was less in favor of them.

After analyzing birth defects that were previously associated with SSRI use during pregnancy, the researches found that overall use of these anti-depressants does not significantly increase the risk of the babies having heart defects overall, with craniosynostosis (where connections between skull bones close prematurely), omphalocele (intestines or other abdominal organs protrude from the naval).

Carol Louik, assistant professor of epidemiology at Boston University's Slone Epidemiology Center and the lead author of the first study thinks that although "these studies make a large contribution to the field, they're not the final word by any means", and that "it's a fairly reassuring message for women who need antidepressants and are pregnant or who plan on becoming pregnant"--the risks are not large, " and the fewer elevated risks observed would only lead to very small absolute risks.

Because the other side of the coin should also be considered--should women on anti-depressants continue their medication or should they stop the treatment and risk a relapse during pregnancy?

Previous studies have suggested possible links between the use of anti-depressants by pregnant women and some fetal heart problems as well as birth defects such as withdrawal symptoms in newborns, pulmonary hypertension of the newborn (PPHN, a rare, but serious heart and lung disorder), low birthweight, preterm delivery, etc. But, on the other hand, depressed moms may be more inclined to be health "unconscious" --bad eating habits, alcohol or drug abuse, etc, none of which are good for the fetus. Depression, if untreated, has also been associated with an increase in the risk of miscarriage and again, premature birth and low birthweight.

Dr Jon Shaw, director of child and adolescent psychiatry at the University of Miami's Miller school of Medicine thinks that these studies make a valuable contribution -"It substantiates the need to always be prudent in prescribing antidepressants."

Dr. Michael Katz, acting Medical Director of the March of Dimes, a non-for-profit organization dedicated to the improvement of the health of babies by preventing birth defects, premature birth, and infant mortality, thinks that the studies show just how important post-market surveillance is. "Most prescription drugs are not tested on pregnant women, so we must start monitoring the effects of these medications as soon as they reach consumers, and keep monitoring for as long as it takes to get good data on risks to mothers and babies." Furthermore, most prescription drugs and specially anti-depressants are not tested on pregnant women, says Dr. Katz, "So we must keep monitoring the effects of these medications for as long as it takes to get good data on risks to mothers and babies."

What should future moms feeling blue do? Should they stop taking anti-depressants during pregnancy? "There's a careful tightrope that patients and doctors have to walk to minimize exposure to antidepressants but to avoid depression in pregnancy as well," says Charles Lockwood, chair of obstetrics, gynecology, and reproductive science at Yale University School of Medicine and spokesperson for the American College of Obstetricians and Gynecologists. Every expecting mom, no matter how depressed she is, should be reminded that each pregnancy is the start of a new life - both for her still unborn baby and for herself.

Therefore, mothers should be very careful and closely work with their doctors before considering antidepressants during pregnancy.

source:www.emaxhealth.com