New data show heightened risk of birth defects with antidepressants

January 18, 2017, University of Montreal

A new Université de Montréal study in the British Medical Journal reveals that antidepressants prescribed to pregnant women could increase the chance of having a baby with birth defects.

The risk - 6 to 10 %, versus 3 to 5 % in women who do not take the drugs - is high enough to merit caution in their use, especially since, in most cases, they are only marginally effective, the study says.

"In , you're treating the mother but you're worried about the unborn child, and the benefit needs to outweigh the risk," said the study's senior author, Anick Bérard, a professor at UdeM's Faculty of Pharmacy and researcher at its affiliated children's hospital, CHU Sainte-Justine.

A well-known expert in pregnancy and , Bérard has previously established links between antidepressants and , gestational hypertension, miscarriages and autism. Her new study is among the first to examine the link to birth defects among depressed women.

Every year, about 135,000 Quebec women get pregnant, and of those, about 7 % show some signs of depression, mostly mild to moderate. A much smaller percentage - less than one per cent - suffers from .

In her study, Bérard looked at 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 per cent - took antidepressants in the first three months.

"We only looked at the first trimester, because this is where all the organ systems are developing," said 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 fetus, which can result in malformations.

"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," the study says.

For example, when Celexa (the brand name for citalopram) was taken in the first trimester, the risk of major jumped from 5 per cent to 8 per cent, Bérard found. In all, 88 cases of malformations were linked to use of the drug.

Similarly, use of Paxil (paroxetine) was associated with an increased risk of heart defects; venlafaxine (Effexor), with lung defects; and tricyclic antidepressants (such as Elavil), with increased eye, ear, face and neck defects.

Depression is on the rise across the globe and is a leading cause of death, according to the World Health Organization. Depression is particularly serious during pregnancy, and doctors - especially psychiatrists, obstetricians and other specialists - are prescribing more antidepressants than ever to expectant mothers.

Over the decade or so that Bérard studied her cohort, 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 tend to be older, live alone or be on welfare; they also may have other ailments such as diabetes, hypertension and asthma, the new study shows. The women generally don't have the financial means, leisure time or support to seek other solutions, such as exercising regularly or consulting with a psychotherapist.

"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," Bérard said.

"Given that an increasing number of are diagnosed with depression during pregnancy, (the new) results have direct implications on their clinical management," the study concludes.

"This is even more important given that the effectiveness of 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."

Explore further: Antidepressant drug linked with increased risk of birth defects when taken in early pregnancy

More information: "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," by Anick Bérard, Jinping Zhao and Odile Sheehy, published in BMJ Open on January 12, 2017. DOI: 10.1136/bmjopen-2016-01337

Related Stories

Antidepressant drug linked with increased risk of birth defects when taken in early pregnancy

January 5, 2016
Using paroxetine—a medication prescribed to treat conditions including depression, obsessive-compulsive disorder, anxiety and posttraumatic stress disorder—during the first trimester of pregnancy may increase newborns' ...

World's only super-database for pharmaceutical use during pregnancy

January 22, 2015
Should a woman prescribed antidepressants continue taking them while pregnant? The question is fraught—her health and that of her unborn child is at stake. Yet research to help her and her doctor make that decision is incomplete.

Taking antidepressants during pregnancy increases risk of autism by 87 percent

December 14, 2015
Using antidepressants during pregnancy greatly increases the risk of autism, Professor Anick Bérard of the University of Montreal and its affiliated CHU Sainte-Justine children's hospital revealed today. Prof. Bérard, an ...

Quitting smoking during pregnancy: Beneficial for both mother and child

July 19, 2016
The results of a study conducted by Dr. Anick Bérard, Professor and Fonds de recherche du Québec - Santé Research Chair on Medications and Pregnancy, at the University of Montreal's Faculty of Pharmacy and the Ste-Justine ...

Pregnancy antibiotics no cause for concern, study shows

October 30, 2015
The four out of ten women who use antibiotics during pregnancy can breathe easy, as a comprehensive new study shows that the two most often prescribed drugs have no adverse outcome on the child's physical development. The ...

Recommended for you

Undiagnosed STIs can increase negative PMS symptoms

September 17, 2018
Women that have undiagnosed sexually transmitted infections may be at greater risk of experiencing negative premenstrual symptoms (PMS), according to new Oxford University research.

High dose folic acid does not prevent pre-eclampsia in high risk women

September 13, 2018
Taking high dose folic acid supplements in later pregnancy (beyond the first trimester) does not prevent pre-eclampsia in women at high risk for this condition, finds a randomised controlled trial published by The BMJ today.

Study finds air purifiers may benefit fetal growth

September 12, 2018
A new study led by SFU health sciences researchers Prabjit Barn and Ryan Allen reveals fetal growth may improve if pregnant women use portable air purifiers inside their homes.

Delayed childbearing is a growing source of multiple births, study shows

September 12, 2018
Starting in the 1980s, the number of multiple births—twins, triplets, quadruplets and quintuplets—steadily increased from about 20 sets per 1,000 live births to almost 35 sets per 1,000 live births in the 2010s.

Transforming pregnancy research with a smartphone app

September 5, 2018
For years, pregnant women have been underrepresented in biomedical research. Current treatments, interventions and guidelines do a poor job of taking into consideration the diverse characteristics of all pregnant women.

For women undergoing IVF, is fresh or frozen embryo transfer best?

August 21, 2018
The world's first baby born via in-vitro fertilization turned 40 years old this summer. Still, after four decades, IVF is a relatively new field with ongoing debate on how to get the best results for families who have placed ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.