Antidepressants in pregnancy linked to heightened risk of birth defects

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Antidepressants in pregnancy linked to heightened risk of birth defects Researchers urge caution on use of antidepressants in pregnancy

Ingrid Torjesen

Thursday, 19 January 2017

Use of antidepressants in pregnancy appears to increase the risk of birth defects by around twofold, a Canadian study* published in BMJ Open has found.

The study included 18,487 depressed women in the Quebec Pregnancy Cohort, a longitudinal, population-based grouping of 289,688 pregnancies recorded between 1998 to 2009. Of the women studied, 3,640 - about 20% - took antidepressants in the first three months.

Antidepressant classes (selective serotonin reuptake inhibitors (SSRI), serotonin–norepinephrine reuptake inhibitors (SNRI), tricyclic antidepressants (TCA) and other antidepressants) were compared with non-exposure during the first trimester (depressed untreated) and major congenital malformations overall and organ-specific malformations in the first year of life were identified.

Only citalopram increased the risk of major congenital malformations, but antidepressants with serotonin reuptake inhibition effect - SSRIs, SNRIs andamitriptyline (the most used TCA) - increased the risk of certain organ-specific defects: paroxetine increased the risk of cardiac defects and ventricular/atrial septal defects; citalopram increased the risk of musculoskeletal defects and craniosynostosis); TCAs were associated with eye, ear, face and neck defects, and digestive defects; and venlafaxine was associated with respiratory defects.

Professor Anick Bérard, of the faculty of pharmacy at the University of Montreal and researcher at its affiliated children"s hospital, CHU Sainte-Justine, said: "We only looked at the first trimester, because this is where all the organ systems are developing," said Professor Bérard. "At 12 weeks of gestation, the baby is formed."

Antidepressant use during this critical time-window has the potential to interfere with serotonin intake by the foetus, which can result in malformations, she explained. "Serotonin during early pregnancy is essential for the development of all embryonic cells, and thus any insult that disturbs the serotonin signaling process has the potential to result in a wide variety of malformations.”

Over the period of the study, the proportion of expectant mothers on antidepressants in Quebec doubled, from 21 users per 1,000 pregnancies in 1998 to 43 per 1,000 in 2009. Those using the drugs tended to be older, live alone or be on welfare; they were also more likely to have other ailments such as diabetes, hypertension and asthma.

Professor Bérard said: "There are a multitude of ways to get mild to moderate depression treated, but you need to have the time and money and also the encouragement to take advantage of them."

She added 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”. "Hence, the need for caution with antidepressant use during pregnancy is warranted and alternative non-drug options should be considered," she said.

* Bérard A, Zhao J-P, 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, January 2017. DOI: 10.1136/bmjopen-2016-013372

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