First Trimester Pregnancy Use of Antidepressants
Pregnant mothers who have depression or are at the risk of depression are often concerned about the effects of antidepressants on their developing babies. A study published in late June (full abstract is included below) suggested that risks of 3 types of birth defects - craniosynostosis, omphalocele, or heart defects - were not significantly increased with SSRI use overall. However, there appeared to be a slight increase in risk in certain birth defects with certain types of antidepressants: paroxetine (brand name Paxil) and sertraline (brand name Zoloft) were two medications found to have associated increase in certain birth defects. The authors concluded that the absolute risk of birth defects due to antidepressant use during the first trimester of pregnancy is small.
“First-Trimester Use of Selective Serotonin-Reuptake Inhibitors and the Risk of Birth Defects” by Carol Louik, Sc.D., Angela E. Lin, M.D., Martha M. Werler, Sc.D., Sonia Hernández-Díaz, M.D., Sc.D., and Allen A. Mitchell, M.D. Published in New England Journal of Medicine (NEJM) Volume 356:2675-2683, June 28, 2007, Number 26.
ABSTRACT
Background The risk of birth defects after antenatal exposure to selective serotonin-reuptake inhibitors (SSRIs) remains controversial.
Methods We assessed associations between first-trimester maternal use of SSRIs and the risk of birth defects among 9849 infants with and 5860 infants without birth defects participating in the Slone Epidemiology Center Birth Defects Study.
Results In analyses of defects previously associated with SSRI use (involving 42 comparisons), overall use of SSRIs was not associated with significantly increased risks of craniosynostosis (115 subjects, 2 exposed to SSRIs; odds ratio, 0.8; 95% confidence interval [CI], 0.2 to 3.5), omphalocele (127 subjects, 3 exposed; odds ratio, 1.4; 95% CI, 0.4 to 4.5), or heart defects overall (3724 subjects, 100 exposed; odds ratio, 1.2; 95% CI, 0.9 to 1.6). Analyses of the associations between individual SSRIs and specific defects showed significant associations between the use of sertraline and omphalocele (odds ratio, 5.7; 95% CI, 1.6 to 20.7; 3 exposed subjects) and septal defects (odds ratio, 2.0; 95% CI, 1.2 to 4.0; 13 exposed subjects) and between the use of paroxetine and right ventricular outflow tract obstruction defects (odds ratio, 3.3; 95% CI, 1.3 to 8.8; 6 exposed subjects). The risks were not appreciably or significantly increased for other defects or other SSRIs or non-SSRI antidepressants. Exploratory analyses involving 66 comparisons showed possible associations of paroxetine and sertraline with other specific defects.
Conclusions Our findings do not show that there are significantly increased risks of craniosynostosis, omphalocele, or heart defects associated with SSRI use overall. They suggest that individual SSRIs may confer increased risks for some specific defects, but it should be recognized that the specific defects implicated are rare and the absolute risks are small.
You may also read an interpretation of this and other related studies at the Wall Street Journal Health Blog.
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2 Responses to “First Trimester Pregnancy Use of Antidepressants”
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My girlfriend who had been on antidepressants for years prior to conceiving, went off her medications at the advice of her doctor after weighing the possible effects on her child. She would have been at about 10 weeks on Monday, and committed suicide last night. We are all in shock. It seems that the greatest harm to the development of the fetus is the loss of the mother. Low birth weight and a few weeks premature look acceptable to me in light of today’s events. Yours is the first information I read today that has even suggested it is perfectly fine for a mother-to-be to continue her treatment. Please make this side of the arguement be heard with a more powerful voice.
Hi Amy,
I’m so sorry to hear about your friend. I’ve been getting more emails relating to the risk/benefit ratio of antidepressants during pregnancy, and in the past I’ve also reviewed a book by a medical doctor who looks at depression before, during, and after pregnancy. Resources for pregnancy and depression remain scarce!
It’s very easy to make blanket judgments on ’stopping all meds’ when a woman is pregnant, yet for some who suffer from clinical depression and become pregnant, the decision is not that simple. It is indeed true that the most harm to the baby occurs when the mother harms herself, and in tragic cases, ends her life due to a very treatable illness. I believe that our doctors - especially ob/gyns who see pregnant women - may need to be more vigilant about looking at individual patients’ risk factors and weigh the risks of depression in the big picture.
My condolences,
Jane