Antidepressants have long been thought to increase risks of birth defects in newborns, but no hard and fast correlations could be determined until now. In the past, there had been vague associations with sertraline use (the drug component in Zoloft) and five different birth defects, but none could be proven. Since antidepressant use has increased exponentially since 1988 (by close to 400 percent between then and 1994 and 2005-2008 according to Harvard Health), the researchers set out to nail down concrete statistics.
Due to some of these alarming, yet general birth defect and antidepressant links, the Food and Drug Administration (FDA) issued an advisory to users of the drug paroxetine in 2005. They warned that it may cause heart defects in infants if mothers used it during pregnancy. The warning prompted a number of studies around the potential risk, but all were inconclusive.
The researchers stated, "[T]he inconsistent reports have limited opportunities for clinicians to carefully evaluate the risk compared with benefit of specific SSRIs for given patient during pregnancy." So finally, the Centers for Disease Control (CDC) stepped in to try and find definitive answers in the mountains of data.
They looked at 17,952 mothers of children born with birth defects, and 9,857 mothers of children without birth defects born between 1997 and 2009 at 10 different centers. Of those 27,809 mothers, 1,285 were taking a form of SSRI (selective serotonin reuptake inhibitors) one month before conception through the first trimester of pregnancy. The study focused on mothers taking SSRIs during this critical period, because it's thought to be the time when the fetus is most susceptible to things the mother is ingesting.
The SSRIs from most to least commonly taken at the time of the study were Zoloft (sertraline), Prozac (fluoxetine), Paxil (paroxetine), Celexa (citalopram) and Lexapro (escitalopram). Thankfully, the CDC could not confirm the link of sertraline use to any of the five birth defects with which it was once associated. This is particularly reassuring news since it's the most common antidepressant prescribed and used.
However, the good news stops there. The CDC did confirm a link between paroxetine (Paxil) and anencephaly, in which a baby is born without parts of the brain and skull. A link was also found between fluoxetine (Prozac) and heart defects and craniosyntosis, which negatively impacts the joints in a baby's skull. That being said, while the risks of an infant being born with these defects is higher if the mother is taking these drugs, it's still a relatively small risk, like the difference of 2 in 10,000 versus 7 in 10,000.
Women have been cautioned away from using antidepressants during their pregnancy, especially during the critical first trimester for several years now. However, Jennita Reefhuis, lead author of the study and an epidemiologist in the birth defects branch of the CDC, knows it's not so easy for many women to just stop their depression treatments. While the study does confirm links to certain SSRIs along with increased risks of birth defects, it doesn't mean you shouldn't consider taking them if your symptoms are unmanageable.
In the long run, it's better to have your depression under control for the birth of your baby with a slight increase in birth defect risk, than go through this massive life change while emotionally unstable.
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