July 20, 2007

Antidepressant use during pregnancy raising concerns

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Antidepressant use by women who are pregnant is rising despite safety concerns. (photo by Susan Urmy)

Antidepressant use during pregnancy raising concerns

Research led by a physician at the Monroe Carell Jr. Children's Hospital at Vanderbilt shows that the number of women who use antidepressant drugs during pregnancy is rising despite a lack of proof the drugs are safe for their unborn babies.

The study, published recently in the American Journal of Obstetrics and Gynecology, combed data from the medical records of more than 100,000 pregnant women in the TennCare system between 1999 and 2003.

William Cooper, M.D., associate professor of Pediatrics at the Children's Hospital and the study's principal investigator, said the records show the use of antidepressant medications increased from 5.7 percent of pregnancies is 1999 to 13.4 percent of pregnancies in 2003.

“We were a little surprised by the increase because many women stop taking medications when they find out they are pregnant,” Cooper said. “It highlights the importance of knowing more about these medicines, especially during pregnancy. We just don't know enough to make informed decisions about the use of many drugs for pregnant women.”

Exposure to antidepressants during early and late pregnancy has been associated with birth defects of the heart and high blood pressure in the baby's lungs, but the data is limited. The most common type of antidepressants used in this study was selective serotonin reuptake inhibitors, but Cooper found exposure to all types of antidepressants was more frequent in the first trimester than the second or third.

The numbers also showed mothers who were older (over 25), Caucasian, and who had higher education levels were more likely to take antidepressants during pregnancy than other women.

Cooper is quick to say the study doesn't suggest women who suffer from clinical depression should not be treated during pregnancy; rather, he says, it shows the importance of studying potential side effects for babies more thoroughly.

“It is important to note that untreated depression can also put the baby at risk. This study points to a need for women to work with their health care provider to find the best treatment plan that works for them.”

This collaborative study with the Food and Drug Administration may lead to further research nationally. Cooper said TennCare data are a great place to start for a study like this because 50 percent of women giving birth in Tennessee are on TennCare. The large, diverse population is a good testing ground for the FDA's theories about potential problems within the medication prescribing system nationwide.

“It's a large population with a broad variety of life circumstance,” Cooper said. “That gives more weight to the findings and indicates that health care providers who care for women — and women who may become pregnant — need to be given clear information about the safety of these medications. We don't have that information to give them now.”

Also contributing to the study were Wayne Ray, Ph.D., professor of Preventive Medicine and director of the Division of Pharmacoepidemiology, Mary Willy, Ph.D., an epidemiologist at the FDA, and Stephen Pont, M.D., instructor in Clinical Pediatrics.