New Data Show Heightened Risk of Birth Defects When Antidepressants Are Used During Pregnancy

MONTREAL -- January 19, 2017 -- A study published in the British Medical Journal (BMJ) reveals that antidepressants prescribed to pregnant women could increase the chance of having a baby with birth defects.

The 6% to 10% risk, compared with 3% to 5% in women who do not take antidepressants, is high enough to merit caution in their use, especially since in most cases, they are only marginally effective.

“In pregnancy, you’re treating the mother but you’re worried about the unborn child, and the benefit needs to outweigh the risk,” said senior author Anick Bérard, MD, Université de Montréal, and CHU Sainte-Justine, Montreal, Quebec.

For the study, the researchers looked at 18,487 women with depression in the Quebec Pregnancy Cohort, a longitudinal, population-based grouping of 289,688 pregnancies recorded between 1998 and 2009. Of the women studied, 3,640 (~20%) took antidepressants in the first 3 months.

“We only looked at the first trimester, because this is where all the organ systems are developing,” said Dr. Bérard. “At 12 weeks of gestation, the baby is formed.”

Antidepressant use during this critical time-window has the potential to interfere with serotonin intake by the fetus, which can result in malformations.

“Serotonin during early pregnancy is essential for the development of all embryonic cells, and thus any insult that disturbs the serotonin signalling process has the potential to result in a wide variety of malformations,” the authors wrote.

When citalopram was taken in the first trimester, the risk of major birth defects jumped from 5% to 8%. In all, 88 cases of malformations were linked to use of the drug.

Similarly, use of paroxetine was associated with an increased risk of heart defects; venlafaxine with lung defects; and tricyclic antidepressants with increased eye, ear, face, and neck defects.

Over the decade or so that Bérard studied her cohort, the proportion of expectant mothers on antidepressants in Quebec doubled, from 21 users per 1,000 pregnancies in 1998 to 43 per 1,000 in 2009.

Those using the drugs tended to be older, live alone or be on welfare; they also may have other ailments such as diabetes, hypertension, and asthma. The women generally don’t have the financial means, leisure time or support to seek other solutions, such as exercising regularly or consulting with a psychotherapist.

“There are multitudes of ways to get mild to moderate depression treated, but you need to have the time and money and also the encouragement to take advantage of them,” Said Dr. Bérard.

“Given that an increasing number of women are diagnosed with depression during pregnancy, results [of the current study] have direct implications on their clinical management,” the authors concluded. “This is even more important given that the effectiveness of antidepressants during pregnancy for the treatment of the majority of cases of depression have been shown to be marginal. Hence, the need for caution with antidepressant use during pregnancy is warranted and alternative non-drug options should be considered.”

SOURCE: Universite de Montreal
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