Mothers’ Antidepressants Linked to Problems in Newborns

NewScientist.com
February 8, 2006
By Roxanne Khamsi

Prenatal exposure to certain antidepressants appears to increase a newborn’s risk of exhibiting drug withdrawal symptoms and respiratory abnormalities, according to two new studies. Researchers behind the studies urge doctors to carefully consider these findings before prescribing this type of medication to pregnant women.

The use of SSRI antidepressants in pregnant women increased the risk of a respiratory disorder – persistent pulmonary hypertension (PPHN) – in the newborn by 600%. This was the finding of a new retrospective study which included 377 women whose infants had the disorder.

SSRIs, or selective serotonin-reuptake inhibitors, work by increasing the availability of the chemical messenger serotonin in the body.

Mothers of infants with PPHN were interviewed by Christina Chambers at the University of California, San Diego, US, and colleagues to determine how many of them used SSRIs during pregnancy. The team then compared this with the use of SSRIs among mothers of healthy babies.

Lungs and muscle

Their analysis showed that women using these antidepressants after the 20th week of gestation had a higher risk of giving birth to a baby with PPHN. This relatively rare respiratory disorder occurs in an estimated one to two infants per 1000 live births in the US. It is a dangerous condition and, despite treatment, 10% to 20% of affected newborns do not survive.

Babies with PPHN typically show abnormal muscle cell growth in their respiratory system. Previous investigations have found that SSRIs tend to accumulate in adult users' lungs and serotonin can promote the proliferation of certain muscle cells. This may explain how the drugs could have an effect on the developing fetus, writes the team in the New England Journal of Medicine.

The researchers stress, however, that a pregnant woman taking SSRIs appears to have a relatively small risk – about 1% – of delivering a child with PPHN.

Severe withdrawal

A second study, which appears in the Archives of Pediatrics & Adolescent Medicine reports that nearly one-third of infants born to women taking SSRIs show symptoms of withdrawal – such as high-pitched crying, tremors, gastrointestinal problems and disturbed sleep – shortly after delivery. The researchers found that 13% of the 60 newborns exposed to these antidepressants showed severe withdrawal symptoms.

These two new papers add to an increasing body of knowledge about how antidepressants might affect a developing fetus. And regulatory bodies have begun to take action based on this type of research.

In December 2005 the US Food and Drug Administration stated that the use of [a certain] SSRI ... during the first trimester was associated with an increased risk of birth defects as compared with the use of other SSRIs, or no use of antidepressants.

Balance of care

But medical experts estimate that 10% to 15% of women of reproductive age suffer from major depressive disorders. And many of these doctors stress that pregnant women should receive treatment for depression, even if that means taking SSRIs.

“They’re so many issues that are involved,” says Chambers. “The risks and benefits have to be weighed. There are risks without [the antidepressants] as well.”

A study that recently appeared in the Journal of the American Medical Association suggested that women with major depression can suffer a recurrence of their condition if they stop taking their medication during pregnancy.

Journal references: New England Journal of Medicine (DOI: 10.1056/NEJMoa052744), Archives of Pediatrics and Adolescent Medicine (DOI: 10.1001/archpedi.106.2.173)

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