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Feature article

Antidepressants During Pregnancy:  A Safe Combination?

New research confirms caution is indicated

A study published in late 2015  looked at pregnant women who took one of five SSRIs (a group of antidepressant medications targeting the neurotransmitter Serotonin) during pregnancy and who received care between 1997 and 2009 at 10 sites in the United States. It compared women who took an SSRI and had a baby with a birth defect vs women taking the same SSRI whose live-born babies did not have a major birth defect. A statistical analysis  combined results from the published literature with over 12 years of data from the National Birth Defects Prevention Study, which is one of the largest collaborative, case-control studies aimed at understanding factors Antidepressantsthat increase the risk for major birth defects in the United States.

The study did not see some earlier reported links but confirmed other links previously observed between birth defects and some SSRIs when taken during early pregnancy. Some birth defects occur two to three times more frequently among babies born to women who took certain types of SSRI medications, like paroxetine (Paxil) and fluoxetine (Prozac), early in pregnancy.

Previous studies have reported links between fluoxetine use and four types of birth defects. Our study confirmed two of these links: heart defects that obstruct the right ventricular outflow tract and craniosynostosis (a premature fusion of bones in infant‘s skull). The study also confirmed five of seven previous links between paroxetine use and certain birth defects, including anencephaly (missing brain), and some heart defects. 

Reassuringly,  links between sertraline (Zoloft),  the SSRI used most often, and any of the birth defects observed in previous studies were not confirmed. Additionally, previous studies had shown links between the use of citalopram and escitalopram and certain birth defects, but this study did not definitively confirm any of those findings. However, citalopram (Celexa) and escitalopram (Lexapro) were the least commonly used SSRIs by pregnant women in the study population.

It is important to note that although the study found increased risks for a few types of birth defects among women using certain types of SSRIs, the absolute risk for a birth defect in an infant born to a mother taking one of these medications is small. For example, a woman's chance of having a child with a heart defect that obstructs the right ventricular outflow tract is about 10 per 10,000 births. If she took paroxetine in early pregnancy, that risk could increase to about 24 per 10,000 births.

Conclusion:  Research continues into the effects of NOT continuing to take antidepressants when a woman gets pregnant - and how recurring depression can also have negative impacts. But it is clear that there is a chance, even if small, that taking antidepressant medications can have undesirable consequences on the baby’s health. 
At this stage in the research, there is no definite answer to the question of whether or not to take these medications. Being aware of the risks and discussing these with your doctor and then making an informed decision about continuing or discontinuing SSRI use during and even before pregnancy is important. There are also treatments for depression without medications. Consult with a behavioral health provider or see an EAP consultant to learn more about these options.

Reference:  Reefhuis J, Devine O, Friedman JM, Louik C, Honein MA; National Birth Defects Prevention Study. Specific SSRIs and birth defects: Bayesian analysis to interpret new data in the context of previous reports. BMJ. 2015;351:h3190.

For more information, please visit www.cdc.gov/treatingfortwo.


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