Study says antidepressants don't cause birth defects

In this story:

• But not everyone is convinced
• Prozac not included in study
• 'A burning issue'
• Related sites and stories

February 24, 1998
Web posted at: 9:21 p.m. EST (0221 GMT)

ATLANTA (CNN) -- A study of three widely used new anti-depressants -- Paxil, Zoloft and Luvox -- has found that they do not appear to cause birth defects.

About half of the 534 women from the United States and Canada who participated in the study took the antidepressants at least through the first trimester and had rates of birth defects, still-births and spontaneous or elective abortions similar to those not taking the drugs.

"Our study confirms animal experiments by showing that when used in the recommended doses, the (antidepressants) do not appear to increase the risk of congenital malformations," wrote Nathalie Kulin and Gideon Koren of The Hospital for Sick Children and the University of Toronto.

The study was published in Wednesday's Journal of the American Medical Association, and not everyone finds the results convincing.

An expert not associated with the research called the findings reassuring, but because the study looked at only 267 expectant mothers, he said it was far too small to establish that the drugs are safe during pregnancy.

"I don't gain complete confidence with this study," said Dr. Richard Schwarz, obstetrical consultant for the March of Dimes. "I don't think the studies are statistically powerful enough for us to be able to stand up and say 'Go ahead and take these drugs. There's no problem at all.'"

Prozac not included in study

The widely used antidepressant Prozac was not included in the study, but an earlier study linked Prozac to premature births. Another study, however, found that Prozac did not appear to harm the mental development of the baby.

All four of the drugs are part of a relatively new class of antidepressants called Selective Serotonin Reuptake Inhibitors. They are also used to treat panic disorder, obsessive-compulsive disorder and bulimia.

"Because more than half of all pregnancies are unplanned and an estimated 8 percent to 20 percent of all women suffer from depression," the researchers wrote, "fetal safety is a primary concern."

The researchers studied 267 women who had been taking one of the three drugs when they learned of their pregnancies, and 267 pregnant women who were not exposed to anything known to cause birth defects.

In the antidepressant group, 222 live births occurred and nine babies had major physical defects, a rate of 4.1 percent. In the comparison group, 235 live births occurred and nine babies had major defects, for a rate of 3.8 percent.

The researchers said the difference in rates was so small that it could have been caused by chance.

The study did not explore behavioral differences in the babies, but birth weights and rates of spontaneous abortions and still-births were the same between the two groups. There were no apparent differences between women who took antidepressants throughout their pregnancies and those who took them only during the first trimester.

'A burning issue'

"This has been a burning issue in the field of both psychiatry and obstetrics and gynecology in a sense of when you have maternal mental health and medication exposure, how do you strike the balance?" says Dr. Zachary Stowe, a psychiatrist at Emory University.

Stowe said that psychiatrists have found that "children's health in the first year of life was not quite as good if mom was significantly depressed or untreated during pregnancy or post-partum."

The March of Dimes' Schwarz, who is also chairman of obstetrics and gynecology at New York Methodist Hospital, said women who are taking antidepressants and are thinking of getting pregnant should see their doctors to help them decide.

Women who are being treated because they "feel a little down in the dumps" might decide they could get along without a drug for a few months, he said.

"If, on the other hand, you're seriously incapacitated or maybe even suicidal," he said, "then to stop it would be foolish."

Correspondent Dr. Steve Salvatore and The Associated Press contributed to this report.

CNN In-Depth Health:

• Parenting
• Pregnancy

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Related sites:

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• The Hospital for Sick Children, Toronto
• University of Toronto Faculty of Medicine
• Journal of the American Medical Association
  • New Type of Antidepressant Safe For Pregnant Women - February 25, 1998
• March of Dimes Home Page
• The Robert W. Woodruff Health Sciences Center at Emory University

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