In January, researchers from the Université de Montréal released their findings from a study on the connection between antidepressant use in pregnancy and the risk of birth defects. The study examined 18,487 pregnant women with a diagnosis of depression, taken from a database of 289,688 recorded pregnancies between the years 1998 to 2009. 20% of the 18,487 women who identified themselves as depressed took antidepressants during the first trimester of pregnancy. The finding? Women who took antidepressants have an increased risk of delivering a baby with a birth defect.
The study found that use of antidepressants during the first trimester increases the risk of birth defects from 3 to 5% in women who did not take the drugs, to 6 to 10%. The study also examined the types of defects associated with specific antidepressants. The study found that Celexa was associated with a higher risk of major defects and Paxil with heart defects.
Medication Safety Guidelines During Pregnancy
In the United States, the Food and Drug Administration is responsible for a pregnancy safety grading system of over the counter and prescription medications. The categories are distinguished by the letters A, B, C, D, and X. Drugs classified as category A are considered safe for use during pregnancy and category X drugs are strictly off limits, with studies showing that these drugs have caused serious fetal abnormalities in rats.
What’s important to note about these categories is that most antidepressants are labeled as category C, which says that risk to a fetus cannot be ruled out and that laboratory studies on rats have shown these medications to cause birth defects. Despite this rating, many doctors are still prescribing these medications, also known as selective serotonin reuptake inhibitors (or SSRIs) to pregnant patients. When prescribing medications for depression to pregnant patients, the standard of care indicates that the benefit of the medication to the patient must outweigh the risk. The study points out that the majority of cases of depression found in pregnant women are diagnosed as mild to moderate and antidepressants currently on the market do not show much benefit to those with such a diagnosis.
Weigh Options Carefully
The bottom line of the study is that no SSRI has been found completely safe for use during pregnancy. As the study noted, doctors should examine the benefit vs. the risk to the fetus and discuss your options with you. Options outside of medicine exist and the choice to pursue alternative treatment should be carefully considered by both the patient and treating physician.