How Risky Is It to Take Antidepressants While Pregnant?

Our answer--as well as that of the American Congress of Obstetricians and Gynecologists (ACOG)--has always been that certain medications, namely selective serotonin reuptake inhibitors (SSRIs), are safe enough to consider taking during pregnancy. What's more, it can be of greater risk to a baby to be born to a mother suffering from severe depression, because she may have trouble taking care of herself during pregnancy, and may be more likely to abuse drugs and alcohol and to smoke, perhaps as a way to combat stress.

But a compelling New York Times piece outlines several pieces of recent research that seem to raise more questions about the safety of SSRIs. Increasingly, connections are found between women who take them and babies who go on to be born premature, to be diagnosed with autism, to have ADHD, and to have language difficulties. We asked ACOG whether these studies should change the current thinking, and the answer at this point is: No.

"Broad, sweeping policy should not be made based on these kinds of findings," says ACOG spokesperson Aaron Caughey, M.D., professor and chair of the department of obstetrics and gynecology at Oregon Health and Science University, in Portland. "We are concerned about these associations, but the evidence is inadequate." Nothing yet points to a direct link between the medications and problems later on.

Dr. Caughey walked me through what would produce good evidence: "You'd take a really big group of women with major depression--say, 10,000--and randomize them into two groups, prior to pregnancy. For half, we'd wean them off their medication, and have them try other things to help their depression." (He's referring to approaches like cognitive behavioral therapy, exercise, acupuncture.) The other half of the women would stay on their medication. Then in five years, all of the women's children would be evaluated not only for their physical health, but their IQ scores and their behavior and development.

"You can imagine the problems in designing a study like this," he continued. "First, you'd have to identify the women who are going to be pregnant--which would be overwhelmingly expensive. Then you'd have to get certain women to agree to go off their meds, which could be difficult; on the other hand, you'd have other women saying, 'I've read the research--I'm stopping the meds.' There are big challenges to conducting the right, well-designed research. So instead we end up doing a lot of small studies that aren't able to find any cause-and-effect, but point to associations, which aren't definitive."

Dr. Caughey believes that articles like the NYT piece serve as as good reminder of how crucial it is for every woman to discuss the risks and benefits of antidepressants with her doctor or midwife--ideally before becoming pregnant. It's worth asking whether there's a different medication you can be on, or other ways of treating your depression that don't involve meds at all. Of course, it will always depend on your situation, and for some women it may not be possible to go off medication.

The bottom line, says Dr. Caughey: "This is a really good issue to talk about with your provider. It's incredibly important, and for each woman the answer will be different."

Photo: Pregnant woman taking medication via Shutterstock.

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