Depression and pregnancy: Use of selective serotonin reuptake inhibitors in pregnancy

Abstract

Treatment of depression must address somatic complaints (when they exist) and the depression, and when treating women of childbearing age, choice of antidepressant therapy must be based not only on ease of use and lack of side effects, but also on possible effects on the fetus. From a standpoint of toxicity and risk of overdose, selective serotonin reuptake inhibitors (SSRIs) appear to have an advantage and have achieved widespread use. Limited data are available with regard to effects of this class of agents on the developing fetus. Women who called the Pregnancy Safety Hotline during a 17-month period of study were followed prospectively after their inquiry about Prozac, Paxil, and Zoloft. Data were obtained by telephone interview, and birth defects were confirmed by calling the pediatrician with the consent of the mother. In the study period, a total of 2,819 calls were made to the Pregnancy Safety Hotline; 105 (3.7%) of the calls were made by women exposed to SSRIs during pregnancy; 39 (37.1%) were available and consented to a telephone interview during the preliminary study period. In this group there were 6 spontaneous abortions, 6 elective terminations, 6 continuing pregnancies, and 21 delivered infants, No major birth defects were noted; two minor birth defects were found, and a trend was observed for slightly decreased birth weight with increasing duration of treatment. These findings are consistent with previous reports indicating no increase in major malformation rate and a possible slight association with decreased birth weight with longer duration of exposure, but additional data are needed.