Study Links Certain Antidepressants in Pregnancy With Increased Risk of Birth Defects
A new study in the British Medical Journal found that women who took certain antidepressants during the first trimester of pregnancy had a greater risk of having a baby with major congenital malformations. Compared with a 3-5% risk among women with depression who did not take antidepressants, those who did take depression medications had a risk of 6-10%.
“This is even more important given that the effectiveness of antidepressants during pregnancy for the treatment of the majority of cases of depression (mild to moderate depression) have been shown to be marginal,” researchers wrote. “Hence, the need for caution with antidepressant use during pregnancy is warranted and alternative nondrug options should be considered.”
The study included 18,487 women in Quebec, Canada, with depression. About 20% of them (3,640) took antidepressants in their first trimester.
The risk of major congenital malformations rose from 5% to 8% when women took citalopram, researchers reported. Among participants, 88 cases of malformations were linked with citalopram use.
The study also linked paroxetine with an increased risk of heart defects; venlafaxine with lung defects; and tricyclic antidepressants with eye, ear, face, and neck defects.
Researcher Anick Bérard, PhD, of the University of Montreal and CHU Sainte-Justine, Montreal, noted that over the decade she studied the cohort, the proportion of pregnant women who took antidepressants in Quebec doubled from 21 per 1,000 in 1998 to 43 per 1000 in 2009.
“Given that an increasing number of women are diagnosed with depression during pregnancy, these results have direct implications on their clinical management,” the researchers wrote.
Another study, in PLOS ONE, recently reported similar findings: women who took selective serotonin reuptake inhibitors (SSRIs) 3 months before or after becoming pregnant had a small but significantly increased risk of having a baby with major congenital anomalies or being stillborn. According to that study, 6 in 200 pregnancies resulted in stillbirths or infants with a major congenital anomaly when SSRIs were not prescribed. When SSRIs were prescribed, the incidence of adverse outcomes rose to 7 in 200 pregnancies.
Bérard A, Zhao JP, Sheehy O. Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort. BMJ Open. 2017 January 12;7(1):e013372.