Antidepressants Linked to Heart Defects in Newborns
THURSDAY, Sept. 24 -- Women who take certain antidepressants during the first three months of pregnancy may have a slightly increased risk of giving birth to babies with heart defects.
Septal heart defects -- malformations in the wall separating the right side of the heart from the left -- were more common among women taking antidepressants in the first trimester, Danish researchers found. Some of these heart defects resolve on their own, while others require surgery.
The risks were seen in sertraline (trade names Zoloft and Lustral) and in citalopram (Celexa), both of which belong to the class of medications known as selective serotonin reuptake inhibitors (SSRIs).
Women who took more than one SSRI early in their pregnancy had a fourfold higher risk of having babies with this problem, said the authors of a study appearing online Sept. 24 in BMJ.
Still, the authors said the absolute risk is relatively low: 246 women would have to take such medication in order to see one septal heart defect. And 62 mothers would have to take more than one SSRI to see a problem in one child.
"A potential association with malformations must be considered in the choice of treatment of depression during pregnancy," said Dr. Lars Henning Pedersen, lead author and a research assistant in the department of epidemiology at Aarhus University in Denmark. However, "if our data is correct, the absolute risk is low, which must be balanced against the potential substantial risk of under- or untreated depression during pregnancy."
Other experts agree. "Early exposure can slightly increase the risk of heart defects, but the overall risk is still very, very small," added Dr. Jennifer Wu, an obstetrician and gynecologist at Lenox Hill Hospital in New York City.
And discontinuing antidepressants also carries risks.
"The concern with pregnant women with depression, if you take them off their medication, they can have a relapse into severe depression and this could lead to self-destructive behaviors," Wu said.
Previous studies have found that pregnant women who stopped taking their antidepressant medications were five times more likely to relapse than women who continued with the medication.
In the United States, 13 percent of women have taken an antidepressant while pregnant, according to an accompanying editorial.
Recent research has indicated a higher risk of various defects, including heart defects, among pregnant women taking antidepressants, and the U.S. Food and Drug Administration and the American College of Obstetricians and Gynecologists (ACOG) have issued warnings about possible birth defects associated with the use of the SSRI Paxil (paroxetine) by moms-to-be.
But existing studies have yielded conflicting results about dangers associated with specific drugs.
These researchers looked at almost 500,000 children born in Denmark between 1996 and 2003, a time when the number of pregnant women taking antidepressants quadrupled.
Although no overall association was found in this study between mothers taking SSRIs during the first trimester and birth defects in general, there was a doubling in the risk for septal heart defects for women using Zoloft and Celexa, but not Prozac (fluoxetine) or Paxil.
Pedersen recommended more and larger studies to explore the matter.
In August, the American Psychiatric Association in collaboration with ACOG recommended that women with major depression who are pregnant or planning to get pregnant can start or continue with antidepressant drugs, while women who choose to stop taking the drugs should consider psychotherapy.
"Ideally, you'd want to work closely with a psychiatrist and ob/gyn when planning a pregnancy," Wu said. "When you are suddenly pregnant, there's a lot of anxiety involved and other hormones, so it's probably not a good time at that point to try to go off medications, and it certainly should be supervised."
Patients who are relatively stable, on the other hand, could consider going off their medications for the first trimester, knowing that it will take four-to-six weeks for the drug effect to wear off and also knowing that the medications would be resumed at the first sign of a relapse, Wu said.
The National Women's Health Information Center has more on using antidepressants during pregnancy.
Posted: September 2009
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