Antidepressants & risk during pregnancy?
Depression treatment during pregnancy is essential. If you have untreated depression, you might not have the energy to take good care of yourself. You might not seek optimal prenatal care or eat the healthy foods your baby needs to thrive. You might turn to smoking or drinking alcohol. The result could be premature birth, low birth weight or other problems for the baby — and an increased risk of postpartum depression for you, as well as difficulty bonding with the baby.
A decision to use antidepressants during pregnancy is based on the balance between risks and benefits. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is low. Still, few medications have been proved safe without question during pregnancy and some types of antidepressants have been associated with health problems in babies.
Early studies suggested a risk of limb malformation with tricyclic antidepressants, but the risk hasn't been confirmed by more-recent studies. Some research associates use of citalopram, fluoxetine and sertraline with a rare but serious newborn lung problem (persistent pulmonary hypertension of the newborn, or PPHN) when taken during the last half of pregnancy, as well as heart defects affecting the septum — the wall of tissue that separates the left side of the heart from the right side of the heart. Other rare birth defects have been suggested as a possible risk in some studies, but not others. Still, the overall risks remain extremely low.
Which antidepressants should be avoided during pregnancy?
The SSRI paroxetine (Paxil) is generally discouraged during pregnancy. Paroxetine has been associated with fetal heart defects when taken during the first three months of pregnancy.In addition, monoamine oxidase inhibitors (MAOIs) — including phenelzine and tranylcypromine (Parnate) — are generally discouraged during pregnancy. MAOIs can limit fetal growth and aggravate maternal high blood pressure.
Are there any other risks for the baby?
If you take antidepressants throughout pregnancy or during the last trimester, your baby might experience temporary discontinuation symptoms — such as jitters or irritability — at birth. Tapering dosages near the end of pregnancy isn't generally recommended. It's not thought to minimize newborn withdrawal symptoms, and it might pose additional challenges for you as you enter the postpartum period — a time of increased risk of mood and anxiety problems.
Reported risks for the baby include:
· Persistent pulmonary hypertension in the newborn (PPHN), a serious condition of the blood vessels of the lungs.
· Miscarriage.
· Heart defects.
· Birth defects, including anencephaly (affecting the spinal cord and brain), craniosynostosis (affecting the skull), omphalocele (affecting the abdominal organs), and limb malformation.
· Preterm birth (being born before 37 weeks gestation).
· Low birth weight (being born less than 5 pounds, 8 ounces).
In addition, at least one study showed that babies exposed to antidepressants in the womb experienced withdrawal symptoms, such as:
· Breathing problems
· Jitteriness
· Irritability
· Trouble feeding
· Low blood sugar (hypoglycemia)
Some required a short stay (one to four days) in the neonatal intensive care unit. None of these symptoms caused any long-term harm to the baby.
The long-term impact of antidepressant exposure on development and behavior is still unclear. But, studies have not found a significant difference in IQ, behavior, mood, attention, or activity level in children who were exposed to antidepressants in the womb.
It‘s important to keep the risks associated with antidepressant use in pregnancy in perspective. All pregnant women have an average 3% risk of having a baby with any type of birth defect in most cases. When researchers say antidepressants may increase the risk of certain birth defects, they are talking about just a slight increase. For example, one study showed that antidepressants increased the risk that the baby would be born with PPHN by 1%. So, even if you take an antidepressant during pregnancy, the overall risk of your baby having a problem is still very low. Other studies showed different levels of risk associated with antidepressants and PPHN, and 1% is on the high end. So the risk may be even lower.
Quazi Imam, M.D.
Board Certified in Psychiatry.
Board Certified in Addiction Psychiatry.
Board Certified in Geriatric Psychiatry.
Board Certified in Forensic Psychiatry.
Former Assistant Professor of Psychiatry,Mount Sinai School of Medicine, NY.
Child & Adolescent Psychiatrist,Harvard Medical School Trained.
1833 W. Pioneer Parkway Tel: 682-323-4566
Arlington, Texas 76013
Websites: WWW.takemetomydoctor.com
WWW.adhdclinictx.com
Depression treatment during pregnancy is essential. If you have untreated depression, you might not have the energy to take good care of yourself. You might not seek optimal prenatal care or eat the healthy foods your baby needs to thrive. You might turn to smoking or drinking alcohol. The result could be premature birth, low birth weight or other problems for the baby — and an increased risk of postpartum depression for you, as well as difficulty bonding with the baby.
A decision to use antidepressants during pregnancy is based on the balance between risks and benefits. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is low. Still, few medications have been proved safe without question during pregnancy and some types of antidepressants have been associated with health problems in babies.
Early studies suggested a risk of limb malformation with tricyclic antidepressants, but the risk hasn't been confirmed by more-recent studies. Some research associates use of citalopram, fluoxetine and sertraline with a rare but serious newborn lung problem (persistent pulmonary hypertension of the newborn, or PPHN) when taken during the last half of pregnancy, as well as heart defects affecting the septum — the wall of tissue that separates the left side of the heart from the right side of the heart. Other rare birth defects have been suggested as a possible risk in some studies, but not others. Still, the overall risks remain extremely low.
Which antidepressants should be avoided during pregnancy?
The SSRI paroxetine (Paxil) is generally discouraged during pregnancy. Paroxetine has been associated with fetal heart defects when taken during the first three months of pregnancy.In addition, monoamine oxidase inhibitors (MAOIs) — including phenelzine and tranylcypromine (Parnate) — are generally discouraged during pregnancy. MAOIs can limit fetal growth and aggravate maternal high blood pressure.
Are there any other risks for the baby?
If you take antidepressants throughout pregnancy or during the last trimester, your baby might experience temporary discontinuation symptoms — such as jitters or irritability — at birth. Tapering dosages near the end of pregnancy isn't generally recommended. It's not thought to minimize newborn withdrawal symptoms, and it might pose additional challenges for you as you enter the postpartum period — a time of increased risk of mood and anxiety problems.
Reported risks for the baby include:
· Persistent pulmonary hypertension in the newborn (PPHN), a serious condition of the blood vessels of the lungs.
· Miscarriage.
· Heart defects.
· Birth defects, including anencephaly (affecting the spinal cord and brain), craniosynostosis (affecting the skull), omphalocele (affecting the abdominal organs), and limb malformation.
· Preterm birth (being born before 37 weeks gestation).
· Low birth weight (being born less than 5 pounds, 8 ounces).
In addition, at least one study showed that babies exposed to antidepressants in the womb experienced withdrawal symptoms, such as:
· Breathing problems
· Jitteriness
· Irritability
· Trouble feeding
· Low blood sugar (hypoglycemia)
Some required a short stay (one to four days) in the neonatal intensive care unit. None of these symptoms caused any long-term harm to the baby.
The long-term impact of antidepressant exposure on development and behavior is still unclear. But, studies have not found a significant difference in IQ, behavior, mood, attention, or activity level in children who were exposed to antidepressants in the womb.
It‘s important to keep the risks associated with antidepressant use in pregnancy in perspective. All pregnant women have an average 3% risk of having a baby with any type of birth defect in most cases. When researchers say antidepressants may increase the risk of certain birth defects, they are talking about just a slight increase. For example, one study showed that antidepressants increased the risk that the baby would be born with PPHN by 1%. So, even if you take an antidepressant during pregnancy, the overall risk of your baby having a problem is still very low. Other studies showed different levels of risk associated with antidepressants and PPHN, and 1% is on the high end. So the risk may be even lower.
Quazi Imam, M.D.
Board Certified in Psychiatry.
Board Certified in Addiction Psychiatry.
Board Certified in Geriatric Psychiatry.
Board Certified in Forensic Psychiatry.
Former Assistant Professor of Psychiatry,Mount Sinai School of Medicine, NY.
Child & Adolescent Psychiatrist,Harvard Medical School Trained.
1833 W. Pioneer Parkway Tel: 682-323-4566
Arlington, Texas 76013
Websites: WWW.takemetomydoctor.com
WWW.adhdclinictx.com