If you're one of the millions of women suffering from depression, take note. New research examines broader data on the impact of taking SSRIs while pregnant.
Depression is one of the most challenging of mood disorders and it's also relatively common—approximately 8-16% of reproductive-aged American women suffer from it, according to Jennita Reefhuis, Ph.D., an epidemiologist with the Center for Disease Control and Prevention's National Center on Birth Defects and Developmental Disabilities.
The millions of those women who are taking medication to treat their condition will likely be aware of potential risks associated with continuing their regimens during pregnancy, but there has much conflicting information on the subject. Thankfully, new research just published in the BMJ is providing a much closer look at the available data on antidepressants known as SSRIs (selective serotonin reuptake inhibitors) and their association with birth defects.
SSRIs and birth defects
The findings, gathered by American and Canadian researchers including Reefhuis, considered nearly 28,000 mothers who gave birth between 1997 and 2009—about 65% of whom had babies with birth defects.
The good news is it appears that pregnant women who took sertraline (commonly Zoloft) at least once between the month prior to conception and the end of the first trimester suffered no previously reported associations between SSRI use and birth defects. In fact, even as the most popular SSRI, sertraline wasn't linked with a single one of the five previously reported birth defects.
Now, the bad: Five previously reported birth defects associated with paroxetine (commonly Paxil) were detected, including heart and abdominal wall defects and brain and skull formation complications, and two previously reported birth defects associated with fluoxetine (commonly Prozac) were also observed, including heart wall defects and irregular skull shape.
Taking the negative outcomes associated with some SSRIs into consideration, women will be relieved to learn that the uptick in absolute risk is actually quite low. Although it can technically be said that the risk of a birth defect doubles or triples, it's still only 7 per 10,000 (compared to 2 per 10,000) for a brain and skull defect, for example. What's more, taking SSRIs during late pregnancy shouldn't increase risk, according to Reefhuis, the study's lead author. It's really just the first trimester—when the organs are undergoing formation—that's key.
Rise in antidepressent use in pregnancy
Although the data, from the U.S. National Birth Defects Prevention Study, show that less than 4% of mothers use SSRIs while pregnant, that number has been increasing since the 1990s. "Depression can be very serious and many women need to take medications during pregnancy to appropriately manage their symptoms," Reefhuis notes.
As to whether the benefits of taking SSRIs outweigh the risks, that's really a personal choice for each individual to make with her doctor. "Women should talk to their health care provider, ideally before pregnancy, to make informed decisions about treating their depression," Reefhuis adds.
For some, SSRIs will be the right choice. For others, cognitive behavioral therapy (CBT) or alternative therapies like light therapy, mindful yoga and meditation, or acupuncture might be the best path. Regardless, addressing the issue with the help of a qualified professional is imperative to protect mothers-to-be and their babies from elevated stress hormones, including cortisol. In other words, taking care of herself is one of the most important things an expectant woman can do.