Amid continuing concerns about the pregnancy side effects of certain antidepressants, the findings of a new study suggest that the potential risk of harm to the unborn child associated with use of the drugs may be outweighed by the risks associated with leaving depression untreated.
Researchers from New York Presbyterian Hospital/Weill Cornell Medicine published a study this month in the American Journal of Obstetrics and Gynecology (AJOG), which indicated that there may be pregnancy risks associated with a class of antidepressants known as selective serotonin reuptake inhibitors (SSRI), but found that they are justified when weighed against the benefits of treating depression among pregnant women.
SSRI antidepressants are some of the most widely used drugs in the United States and are prescribed to up to 10.2% of pregnant women. However, the side effects of SSRIs, which include blockbuster medications like Zoloft, Paxil, Prozac, Celexa, Lexapro and others, have previously been linked to an increased risk of birth defects, miscarriage, autism, and other problems when used during pregnancy.
“Depending on severity, some women may require pharmacotherapy for treatment of their depression during pregnancy,” the researchers of the latest study note. “Antidepressants, especially selective serotonin reuptake inhibitors (SSRI), are considered first line. Treatment decisions in regard to pharmacotherapy must weigh the relative risks of medication exposure against the risks of untreated maternal depression.”
Researchers indicate that perinatal depression can affect not only the mother, but the fetus as well, and depression before pregnancy can be associated with unhealthy lifestyle choices by the mother, such as smoking, drinking, and drug use, all of which pose a further risk to the developing fetus.
The study notes that SSRIs cross the placenta and that some research has linked SSRIs to an increased risk of miscarriages, heart malformations, persistent pulmonary hypertension and other health problems for the child. However, researchers say that many of the studies did not control for various potential cofounders that could be the cause of such problems. In addition, they note that a number of studies have been published with conflicting findings on whether these associations exist.
“The effect sizes of potential SSRI exposure risks may be small in comparison to the risks of untreated depression for many women,” the researchers concluded. “These risks should be evaluated in the context of a woman’s individual psychiatric illness, which should also be considered an exposure. The risk of moderate or severe depression on both the woman and offspring should not be underestimated.”
Antidepressant Pregnancy Concerns
This research is the latest in a series of studies that highlight potential concerns surrounding pregnancy use of antidepressants.
In a study published in April in the medical journal Pediatrics, researchers from Johns Hopkins also found a link between the use of SSRIs during pregnancy and autism in boys. That study found the risk effectively tripled. However, research into the association has turned up inconsistent results.
In November 2013, a study published in the medical journal Clinical Epidemiology raised questions on whether there was an actual association between autism and SSRIs. The Danish researchers who conducted that study found no such link after looking at data on more than 600,000 children.
However, the Danish findings contradicted a study published in April in the British Medical Journal, which indicated that there is a link between parental depression, antidepressant use and the risk of autism. That study, which looked at 4,429 cases of autism and more than 40,000 controls, finding that women who took any antidepressant while pregnant were about twice as likely to give birth to a child that would later test on the autism spectrum.
In July 2011, researchers from Kaiser Permanente reported that the use of SSRI antidepressants while pregnant was linked to twice the risk of giving birth to an autistic child.
In addition to autism, many popular antidepressants have been linked to a risk of serious health problems for children exposed to the medication before birth, including septal heart defects, skull malformations, neural tube defects, abdominal defects, spina bifida and other serious injuries.
Recent studies have also found that antidepressant use in pregnancy may increase the risk of seizure problems and delay of infant development milestones, such as sitting and walking are affected by antidepressant use during pregnancy.
Pregnancy antidepressant risks have also been linked to a serious respiratory disorder, known as persistent pulmonary hypertension in newborns (PPHN), which may cause insufficient blood flow to the lungs, leading to serious and potentially life-threatening problems.
In recent years, a growing number of Zoloft lawsuits and Paxil lawsuits have been filed in courts throughout the United States on behalf of children born with defects and malformations after exposure to the medication during pregnancy. The complaints allege that the manufacturers of the medications failed to adequately research the risks associated with use of the antidepressant in pregnancy, or provide proper warnings to women about the risk of becoming pregnant while using the medication.