Prozac hit the market in 1988, the first selective serotonin reuptake inhibitor (SSRI) antidepressant approved by the FDA for the treatment of depression. Because it was safer and more tolerable than the antidepressants that preceded it, Prozac was soon the most commonly prescribed antidepressant in the United States.
Duloxetine (sold in the United Sates under the brand name of Cymbalta) is a serotonin-norepinephrine reuptake inhibitor (SNRI) effective for major depressive disorder and generalized anxiety disorder (GAD). Although used fairly commonly in women of child-bearing age, information regarding its reproductive safety has been lacking.
Over the last few years, we have reported on several studies which have suggested an increased risk of certain types of cardiovascular malformations among children exposed to selective serotonin reuptake inhibitors (SSRIs) during pregnancy. The first reports suggested a link between cardiac septal defects and exposure to paroxetine; subsequent studies have also shown elevated risks with the other SSRIIs.Â
While data accumulated over the last 30 years suggest that certain antidepressants may be used with relative safety during pregnancy, our knowledge regarding the risks of prenatal exposure to psychotropic medications is incomplete. Because neuronal migration and differentiation occur throughout pregnancy and into the early years of life, development of the central nervous system (CNS) remains particularly vulnerable throughout pregnancy.
In a recent retrospective cohort study, data collected from linked records from the Women's and Children's Health Network in South Australia were used to investigate neonatal outcomes in children exposed prenatally to selective serotonin reuptake inhibitors (SSRIs). Women were included in this study if they gave birth to a singleton, live-born infant between September 2000 and December 2008 (n = 33,965).
Over the past few years, there have been a large number of studies which have relied on large administrative databases to generate information on the reproductive safety of various medications. One of the strengths of this type of approach is that it provides an opportunity to observe outcomes in a large number of subjects; however, there are certain, very important limitations. A recent study published in the American Journal of Obstetrics and Gynecology helps to understand some of the challenges in interpreting the data generated from these studies.
While we have data on the use of lithium use during pregnancy with regard to risk for congenital malformations, there is much less information on the long-term effects of lithium on neurodevelopment. A recent study from the Perinatal Center of the Leiden University Medical Center provides some reassuring data on the long-term effects of lithium exposure.
Earlier this year we reported on a possible association between first trimester exposure to topiramate (Topamax) and increased risk of cleft lip and palate. In a recent study published by the American Journal of Obstetrics and Gynecology, researches drew upon data from two birth defect databases to further delineate the risks associated with topiramate exposure.
Atypical antipsychotic medications are commonly used for the treatment of schizophrenia and bipolar disorder. Despite the increasing use of these medications in women of child-bearing age, there is still relatively little data regarding the reproductive safety of these medications.Â
There have long been concerns regarding the use of the anticonvulsant valproate (Depakote) during pregnancy. First trimester use of valproate has been associated with a 3-5% risk of neural tube defects, as well as an increased risk of other malformations affecting the heart. In addition, recent reports have indicated that in utero exposure to valproate may also result in lower IQ.
