Antidepressants During Pregnancy
Two new studies have linked the use of Prozac and other similar antidepressants during pregnancy to a higher risk of complications, such as serious respiratory disease, in newborns.
The research involved antidepressants known as selective serotonin reuptake inhibitors, or SSRIs, which include familiar names like Prozac, Paxil and Zoloft.
As Dr. Emily Senay reported on The Early Show, a study published in the New England Journal of Medicine looked at women who took these drugs late in pregnancy and found that their babies were six times more likely to develop a complication known as persistent pulmonary hypertension — which can, in rare occasions, be fatal.
Another study published in this month's Archives of Pediatrics and Adolescent Medicine found that nearly one-third of newborns whose mothers took that same class of antidepressants during pregnancy experienced neonatal abstinence syndrome, which means they had withdrawal symptoms.
Just how dangerous is this for the newborn baby?
Dr. Senay: For the babies that experienced neonatal abstinence syndrome, the symptoms include high-pitched crying, tremors, disturbed sleep, gastrointestinal problems and hypertonicity, which is an abnormal increase in muscle tone. Almost half of the babies in this study that developed this syndrome had severe symptoms. But while these symptoms are uncomfortable, none of the infants with symptoms in this study actually required any treatment.
On the other hand, there's a real danger for the babies in the Journal's study who developed persistent pulmonary hypertension. PPHN is a serious condition that typically involves severe respiratory failure in a newborn infant and requires immediate treatment. Overall, the risk for this disease is very low — only about one in 1,000 babies will get it, normally. But using these drugs in the last trimester ups that risk to about six babies in a thousand, still low, but more of a cause for concern.
Doctors are always telling pregnant women to be careful about just about everything they put in their bodies: drugs, caffeine, cigarettes, artificial sweeteners, and fish, among others. How common is it for pregnant women to take antidepressants?
Dr. Senay: Most women will discontinue the use of any drug that's not absolutely necessary, just as a precaution, but for any disease or condition, you have to weigh the risks of taking the medication versus skipping it. With depression in particular, the stress of pregnancy can worsen the condition and even increase the need for medications. So if a woman suffers from severe depression, there's a very good chance that she'll continue to take antidepressants during her pregnancy.
So what should you do if you're on one of these medications and you're pregnant or are planning to become pregnant?
Dr. Senay: It's important that a woman talk to both her obstetrician and her psychiatrist to determine the appropriate treatment. The goal is to take as low a dose of medication as necessary to avoid any potential for harm to the fetus, but enough so that the health of the mother is not adversely affected. Pregnant women and their doctors must balance the risk of medications harming the fetus against the danger of untreated depression. The symptoms of major depression are severe enough that it may warrant putting a pregnant woman on an SSRI. But if the patient has a milder case of depression, it might be worth reconsidering and trying to get along without it.
If you took antidepressants during your pregnancy, what do you need to watch out for in your baby?
Dr. Senay: Babies whose respiratory systems are affected need immediate treatment, and your doctor should work with you on what to do from there. For infants who experience withdrawal symptoms, the authors of this study say the babies need to be monitored closely after birth for a minimum of 48 hours. After that, they'll need to go for follow-up check-ups regularly, especially those who developed severe symptoms. But further study is needed to assess the long-term effects.