Many women who take antidepressant medications face a difficult question when they are planning for a pregnancy: whether to continue the medication during the pregnancy. Of course, ceasing treatment of a serious condition such as depression presents risks for both mother and fetus. But recent research also raises questions about the safety of certain medications during pregnancy. Specifically, new studies indicate that there may be a connection between selective serotonin reuptake inhibitors (SSRIs) and congenital heart defects. SSRIs are among the most commonly used medications to treat depression, but they also pass easily through the placenta, exposing the fetus to the drug and raising questions about their safe use during pregnancy.
A recently published study out of Finland cautions against the use of certain SSRI medications during pregnancy, given evidence of an increased risk of certain heart defects. The study examined over 600,000 births between the years of 1996-2006 and indicates that taking certain SSRIs during the first trimester of pregnancy increases the risk for major cardiac defects.
Specifically, the drug fluoxetine was associated with a 2-fold increased risk of isolated ventricular septal defects, while the drug paroxetine was associated with 4-fold increase in the risk of right ventricular outflow tract defects. According to researchers, while the overall absolute risk for these cardiac anomalies is small, the fact that there is increased risk when the woman took these SSRIs during pregnancy, should guide clinicians not to consider fluoxetine or paroxetine the first option when prescribing selective seratonin reuptake inhibitors to women planning pregnancy. A previous study, carried out by some of the same researchers, also found this link between paroxetine and fluoxetine and a slightly increased risk for cardiovascular malformations.
A study carried out in Denmark examined a population of 1.6 million individuals between the years of 1991 and 2007. In their analysis, the researchers found that 5.1% of infants exposed to SSRIs had congenital malformations compared to 3.5% of infants who were not exposed. With regards to cardiac malformations specifically, 1.3% of infants exposed to SSRI had cardiac defects compared to .7% of infants who were not exposed. Ultimately the increased risk of congenital cardiac malformations was 1.7 times greater for infants exposed to SSRIs during the pregnancy. Like the Finland study, the overall risk remained low.
Much of the research on SSRI drugs and heart birth defects remains inconclusive; researchers continue to work on determining just how safe antidepressant medications are for both mother and child. In the meantime, it is wise to carefully consider all treatment options with the guidance of your physician and/or psychiatrist to make the best decision for you and your child.