Study Examines Association Between SSRIs, Birth Defect Risks
Abstract
Approximately 70 percent of women think that it is acceptable to take antidepressant medication when not pregnant or breastfeeding, but only 33 percent of women think it is acceptable to do so when pregnant.
Prenatal use of some selective serotonin reuptake inhibitors (SSRIs) may not increase the risk of birth defects in offspring that some previous reports have suggested, according to data published in BMJ.
“Past research has provided conflicting evidence about potential links between the use of SSRIs during pregnancy and certain birth defects,” said the study’s lead author Jennita Reefhuis, Ph.D., an epidemiologist in the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC), during an interview with Psychiatric News.
Reefhuis noted that such conflicting evidence, along with the 2005 Food and Drug Administration advisory warning against the use of the SSRI paroxetine (marketed as Paxil) while pregnant, has weighed heavily on women’s perception of the safety of SSRIs taken during pregnancy, and the research findings on the risks and benefits of specific SSRIs is limited.
To provide a more robust estimate of the association between prenatal use of specific SSRIs and birth defects, Reefhuis and colleagues analyzed data from the U.S. National Birth Defects Prevention Study, one of the largest population based case-controlled studies of birth defects.
The analysis included the records of approximately 18,000 mothers of infants with birth defects and 10,000 mothers of infants without birth defects, focusing on the use of citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft) that occurred at least once in the period from one month prior to conception through the end of the first trimester of pregnancy.
“We accessed only those SSRIs that had been linked, through previous studies, to specific birth defects,” said Reefhuis.
The results showed that though sertraline was the most commonly used SSRI among study participants, none of the five previously reported associations between prenatal use of the drug and birth defects in offspring was confirmed. Additionally, no association with maternal use of citalopram or escitalopram monotherapy was found, except for a marginal association between citalopram and neural tube defects.
The analysis did confirm heart wall defects and craniosynostosis associated with fluoxetine treatment as well as five previously reported birth defects associated with paroxetine use, including heart defects, problems with brain and skull formation, and abdominal wall effects.
“Early pregnancy is a critical time for a baby’s organs to develop, so the best time to discuss the safety of medication use is before pregnancy,” explained Reefhuis. “If health care providers are treating women who are already pregnant, it is important to discuss the risks and benefits of antidepressants as well as the safest options available to treat their mental health condition during pregnancy.”
The study concluded that “continued scrutiny of the association between SSRIs and birth defects is warranted, and additional studies of specific SSRI treatments during pregnancy are needed to enable women and their health care providers to make more informed decisions about treatment.”
The study was funded by the CDC. ■
