Some antidepressants may increase the risk of birth defects if taken early in pregnancy, while others don't seem to pose the same risks, a study finds.
The question of whether antidepressants can cause birth defects has been debated for years, and studies have been all over the map. That makes it hard for women and their doctors to make decisions on managing depression during pregnancy.
To try to untangle the question, researchers at the Centers for Disease Control and Prevention analyzed federal data on more than 38,000 women who gave birth between 1997 and 2009. They looked at the number of birth defects among babies and asked women whether they took any antidepressants in the month before getting pregnant or during the first three months of pregnancy.
The study, published Wednesday in The BMJ, found no association between the most commonly used antidepressant, sertraline (Zoloft), and birth defects. Forty percent of the women who took antidepressants took sertraline.
They also found no increased risk of birth defects with the antidepressants citalopram (Celexa) and escitalopram (Lexapro).
But the analysis did find an association between birth defects and the antidepressants fluoxetine (Prozac) or paroxetine (Paxil). That included heart defects, abdominal wall defects, and missing brain and skull defects with paroxetine, and heart wall defects and irregular skull shape with fluoxetine. The relative risk increased 2 to 3.5 times, depending on the defect and the medication.
That may sound like a lot, but Jennita Reefhuis, an epidemiologist and lead researcher in the study, says "the overall risk is still small."
For the children of women treated with paroxetine early in pregnancy, the absolute risk of brain and skull malformation (anencephaly) rose from 2 to 7 per 10,000 births. For a heart defect, absolute risk increased from 10 to 24 per 10,000 births.
Because this is an association study, it doesn't prove that the medications caused birth defects.
"If you're planning to get pregnant, it really is important to talk with your health care provider to see if there are options and if you could choose a safer option among antidepressants," Reefhuis says. "Of course, not all antidepressants work the same for everybody, so that's something that women need to consult with their health care provider about."
The risks found in this study should be taken in context, says Dr. Edward McCabe, chief medical officer for the March of Dimes Foundation. "This paper showed that those antidepressants that appeared to be less safe do not show as high a risk of birth defects as some of the earlier reports showed, so that's also reassuring."
Some women may try to wean themselves off antidepressants during pregnancy, some may opt for group or individual talk therapy in the interim, and some may switch antidepressants. But any decision, cautions McCabe, should be done in consult with a woman's health care provider; he adds that women should not suddenly stop taking antidepressant medication altogether.
"That can cause serious risk for the woman, including suicide," he says, "and if she's pregnant, even more risk for the developing fetus than the medication itself."
Stress in the mother can increase problems in pregnancy, McCabe notes, including premature birth and low birth weight. "A woman who is experiencing the stress of an uncontrolled depression may be putting her baby at significant risk," he says.
McCabe says he hopes women will understand that "being on an antidepressant should not keep them from having a pregnancy, because they can be put on a drug that's safe for their baby and will control their depression."
DAVID GREENE, HOST:
And now some reassuring news for women who take medication for depression and want to get pregnant. Research has suggested strong links between antidepressants and birth defects. But a new report from the Centers for Disease Control and Prevention finds certain antidepressants are safe, while others carry a small risk of producing birth defects. Here's NPR's Patti Neighmond.
PATTI NEIGHMOND, BYLINE: The findings of studies looking at antidepressants and birth defects are, to say the least, confusing. Some find no link. Some find lots of links. And the birth defects can be severe, including major deficits in brain and heart development that can result in infant death. CDC epidemiologist Jennita Reefhuis analyzed the data from more than 38,000 births over a 12-year period between 1997 and 2009.
JENNITA REEFHUIS: We actually asked these women after the baby was born whether they took any antidepressants during the first three months of pregnancy and the month before pregnancy.
NEIGHMOND: The study, published in The British Medical Journal, found no link between the most commonly used antidepressant, Zoloft - now available as a generic - and birth defects. However, among mothers who took Prozac or Paxil - also available as generics - there was risk, a three to five times increased risk of heart defects and brain defects. That may sound like a lot, but Reefhuis says the overall risk is still small. And for women who suffer depression and need medication, the take-home message is they have a choice.
REEFHUIS: If you're planning to get pregnant, it really is important to go talk to your health care provider so you can see if there are options and if you could choose a safer option among antidepressants. Of course, not all antidepressants work the same for everybody, so that's something that women need to consult with their health care provider about.
NEIGHMOND: Dr. Edward McCabe, chief medical officer for the March of Dimes Foundation, agrees that consulting with your health care provider is critical. And the increased risk among certain antidepressants, he says, should be seen in context.
EDWARD MCCABE: This paper showed that those that appear to be less safe do not show as high a risk of birth defects as some of the earlier reports showed. So that's also reassuring.
NEIGHMOND: With medical guidance, some women may try to wean themselves off antidepressants during pregnancy. Some may opt for group or individual talk therapy in the interim. Some may switch antidepressants. But in any case, McCabe cautions against just stopping medication suddenly. He says that can cause serious risk for the woman, including suicide, and if she's pregnant, even more risk than the medication itself for the developing fetus.
MCCABE: We know that stress is a problem for pregnancies. We know that increased stress can cause premature birth and low birth weight, so that a woman who is experiencing the stress of an uncontrolled depression may be putting her baby and her womb at significant risks.
NEIGHMOND: Bottom line, McCabe says, being on an antidepressant should not keep women from getting pregnant. They can be on a medication that's safe for their baby and also controls their depression. Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.