Scientists found more evidence of a possible link between antidepressant use during pregnancy and an increase risk of birth defects.
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Birth defects were associated with fluoxetine and paroxetine.
The debate over whether or not it’s safe to take antidepressants during pregnancy is heated, with extreme emotions – and conflicting research studies – on both sides.
The associations could not be explained by other factors that influence the risk of birth defects, such as the mother’s ethnicity, education, smoking status and body-mass index.
The findings also suggest that one antidepressant, Zoloft, may be safer than others.
“Continued scrutiny of the association between SSRIs and birth defects is warranted”, the authors wrote, “and additional studies of specific SSRI treatments during pregnancy are needed to enable women and their healthcare providers to make more informed decisions about treatment”.
For their study, the American and Canadian researchers looked at previously conducted studies as well as at a database maintained by the CDC (the Centers for Disease Control and Prevention) – the US National Birth Defects Prevention Study.
She said the work was well done, though she expressed surprise that no associations were found between Zoloft – the most commonly prescribed SSRI – and birth defects, given the previous studies.
In this latest study, researchers in the United States and Canada, wanted to find out if the association between five commonly prescribed SSRIs (citalopram, escitalopram, fluoxetine, paroxetine, and sertraline) and birth defects was real.
The new research examined statistics from nearly 18,000 mothers of infants with birth defects and close to 10,000 other mothers.
Many women who suffer from depression in the period just before conceiving often give up their medications, at the recommendation of their obstetricians.
“The key here is not to tell pregnant women what to do”.
They analysed women who took citalopram, escitalopram, fluoxetine (Prozac), paroxetine or sertraline at least once between the month leading up to conception and the third month of pregnancy.
The researchers excluded any mothers with pre-existing diabetes and mothers who were taking non-SSRI antidepressants. However, Reefhuis and colleagues say that if the link between maternal use of these SSRIs and greater risk of birth defects is causal, the increase in absolute risks is small.
Pregnancy is a time of great change and, for many women, great joy.
Popular antidepressants Paxil and Prozac are linked to higher rates of birth defects, but several similar drugs used to treat depression in pregnant women carry no such risks, a new study found.
Numerous associations reported by other studies were not seen in this one. These included heart defects, problems with brain and skull formation (anencephaly), and abdominal wall defects.
“SSRIs are increasingly used by women of reproductive age and during pregnancy, but the inconsistent reports have limited opportunities for clinicians to carefully evaluate the risk compared with benefit of specific SSRIs for a given patient during pregnancy”, say Reefhuis and colleagues.
These data provide reassuring evidence for some SSRIs, say the authors, but suggest that some birth defects occur more frequently among the infants of women treated with paroxetine or fluoxetine in early pregnancy.
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“Meanwhile, the current analysis can help guide health care providers and women to the safest options for treatment during early pregnancy to minimize the risk of major birth defects, while providing adequate treatment of maternal depression”.
