Mothers who become pregnant while taking an antidepressant are forced to make a difficult choice. Should they stop taking their medication in order to ensure the health of their baby, or should they continue to take their antidepressant to ensure that they don't become depressed? There are pros and cons to each.
While the SSRIs--a class of antidepressant including the drugs Prozac (fluoxetine), Zoloft (sertraline), Luvox (fluvoxamine), Paxil (paroxetine), Celexa (citalopram) and Lexapro (escitalopram)--have been considered relatively safe during pregnancy, there is emerging evidence that they are not entirely without risk.
A study published in the February 9, 2006 issue of the New England Journal of Medicine looked at babies who developed persistent pulmonary hyptertension, which, in rare cases, can be fatal. They found that compared to infants who did not develop this complication, their mothers were more likely to have taken these drugs during late pregnancy. The authors suggest that assuming this relationship is causal, infants exposed to SSRIs in late pregnancy would be six times more likely to develop PPHN than unexposed babies. Although the increased risk is significant, it still translates into approximately six to twelve infants in 1000 vs. one to two infants in 1000 if SSRIs are not used. The authors point out that 99 percent of women exposed to one of these medications late in pregnancy will deliver an infant unaffected by PPHN.
Another study, published in the February 2006 issue of Archives of Pediatrics and Adolescent Medicine, found that nearly one-third of newborns whose mothers took SSRIs during their pregnancy experienced neonatal abstinence syndrome. Infants who experience this syndrome have symptoms such as high-pitched crying, tremors, disturbed sleep, gastrointestinal problems and hypertonicity, which is an abnormal increase in muscle tone. While no medical intervention is necessary for this syndrome, it is uncomfortable for the child.
Research thus far does not seem to indicate any increased risk of major fetal abnormalities following exposure to the SSRIs or other newer antidepressants. Although results have been inconsistent, some studies do indicate increased risk of low birth weight babies.