Antidepressants linked to poor birth outcomes


Antidepressants linked to poor birth outcomes


Usage of a type of antidepressants called selective serotonin reuptake inhibitors (SSRIs) among mothers has been linked to preterm birth, miscarriage, neonatal health problems and potential long-term neurobehavioral conditions, such as autism, according to HMS experts at Beth Israel Deaconess Medical Center in Boston.

The recent study, published in the journal Human Reproduction, said that SSRIs should only be prescribed very carefully for women who are suffering from depression and trying to get pregnant.

"Depression and infertility are two complicated conditions that more often than not go hand in hand. And there are no definitive guidelines for treatment. We hope to provide a useful analysis of available data to better inform decisions made by women and the providers who care for them", said Alice Domar, HMS assistant clinical professor of obstetrics, gynecology and reproductive biology and Executive Director of the Domar Center for Mind/Body Health at Boston IVF. Domar and her team from MetroWest MedicalCenter and Tufts Medical Center analyzed a group of studies published regarding pregnant females who took antidepressants while they were pregnant.

Adam Urato, commented:

"There are three main points that stand out from our review of the scientific studies on this topic. First, there is clear and concerning evidence of risk with the use of SSRI antidepressants by pregnant women, evidence that these drugs lead to worsened pregnancy outcome for moms and babies. And third, we feel strongly that patients, obstetrical providers, and the public need to be fully aware of this information."

Antidepressant use has grown by a whopping 400% in the last 20 years and is now the medication most often prescribed in the U.S for adults between the ages of 18 and 44, the time when most women conceive. In addition, women who are heading into their upper 30s and lower 40s are more likely to have problems becoming pregnant.

However, a report published in 2006 said that women who took antidepressants before they became pregnant and stopped taking them during pregnancy, ran the risk of becoming depressed again.

"According to the Center for Disease Control, more than 1 percent of the babies born in the U.S each year are the result of an IVF cycle," said the authors. "And most women will report symptoms of depression during infertility treatment, especially following unsuccessful treatment cycles."

Eleven percent of women going through fertility therapies say that during the time of treatment, they were taking SSRIs to treat depression, however, Domar and team have not discovered any evidence supporting the use of antidepressants to be linked to better pregnancy results. Instead, the researchers found that antidepressant use is linked to negative pregnancy outcomes. Scientists also discovered a great deal of dispute regarding the effectiveness of SSRIs. Certain trials have found that SSRIs, when compared with placebos, were not more successful for treatment of depression.

The authors continued: "More broadly, there is little evidence of benefit from the antidepressants prescribed for the majority of women childbearing age - and there is ample evidence of risk."

Findings have revealed that SSRIs can hurt the chances of women becoming pregnant if they are experiencing fertility therapies, as well as increase the risk of miscarriage for women who are pregnant.

Congenital abnormalities have also been found to be linked to antidepressant use among mothers; a specific antidepressant called Paxil has been shown to increase risk of cardiac problems. When the link was found, the FDA pushed the GlaxoSmithKline, the maker of Paxil, to alter the medication's risk factor from a C to a D. A rate of D means that the drug may come with the risk of fetal damage.

"Preterm birth is, perhaps, the most pressing obstetrical complication," said the authors. Over 30 trials have proven that antidepressants lead to early delivery of babies.

Urato said: "This is significant finding because we know that babies born before 37 weeks are at risk for many short- and long-term health problems. Caring for premature babies adds up to billions of dollars in health care expenditures."

A study published in the British Journal Of Clinical Pharmacology reported a significant association between the antidepressant fluoxetine and babies being born with heart problems.

Other findings have indicated that when mothers are taking antidepressants they have a higher risk of pregnancy-induced hypertension, as well as preeclampsia. The authors explained: "Given the importance of the hypertensive disorders of pregnancy in terms of maternal and newborn morbidity and mortality, and the widespread of use of antidepressants during pregnancy, further investigation into this area will be essential."

If a woman is taking SSRIs for a long period of time, the authors discovered that this increases the chance of her baby's birth weight being lower than in the 10th percentile range, combined with a high chance of respiratory distress.

The health issues linked to the use of antidepressants go beyond just infancy. The report states that a 2006 trial revealed that when mothers took antidepressants while pregnant, the baby had a 30% chance of developing newborn behavioral syndrome, which is linked to problems feeding, nervousness, and constant crying. Sometimes this syndrome can lead to trouble breathing and seizures, resulting in intubation for the baby.

Slowed development of motor skills among babies and toddlers has also shown to be a risk factor associated with antidepressant use.

A 2011 study by Kaiser Permanente said that exposure to antidepressants during early pregnancy can increase the risk of autism two-fold.

Domar continued:

"There is enough evidence to strongly recommend that great caution be exercised before prescribing SSRI antidepressants to women who are pregnant or who are attempting to get pregnant, whether or not they are undergoing infertility treatment. We want to stress that depressive symptoms should be taken seriously and should not go untreated prior to or during pregnancy, but there are other options out there that may be as effective as, or more effective than SSRIs without all the attendant risks."

The team also analyzed evidence regarding alternative therapies for treating depression, such as exercise, yoga, relaxation intervention, psychotherapy, acupuncture, and nutritional supplements. Of these methods, psychotherapy, in particular CBT (cognitive behavioral therapy), was found to be most effective.

Authors explained: "There is overwhelming evidence that CBT is equivalent to antidepressant medication in the treatment of mild to moderate depression and more recent research indicates that it is effective in the treatment of severe depression as well."

Domar concluded:

"These alternative treatment options may not be appropriate for everyone; still, we think it's important for women on an antidepressant who are considering becoming pregnant to have a conversation with their physician about the risks and benefits of continuing to take their medication. Because at this point in time, with no data to indicate an advantage to taking an SSRI during pregnancy, the research all points to increased risk."


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Section Issues On Medicine: Women health