Most women and their doctors try to avoid using medications during pregnancy. Of greatest concern is that a medication used during pregnancy may in some way harm the developing fetus or, at the very worst, cause a birth defect. But what happens when a pregnant woman needs to take a medication?
There are now data to support the reproductive safety of certain antidepressants, including Prozac (fluoxetine), the older tricyclic antidepressants, and to some extent Celexa (citalopram). Over 2500 women have taken Prozac during pregnancy, and there has been no reported increase in risk for birth defects among exposed children, even when medication was taken during the first trimester. Another study reported good outcomes in 375 children exposed to Celexa during pregnancy. In contrast, we have less information available on the reproductive safety of other antidepressants, such as Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine) and Effexor (venlafaxine). Recent studies suggest that some patients with recurrent depression who have been maintained on an antidepressant may have a difficult time discontinuing antidepressant during pregnancy and are at high risk for becoming depressed again, particularly during the first trimester. If a woman is unable to discontinue antidepressants without getting depressed, she may consider taking an antidepressant during pregnancy, selecting Prozac or another antidepressant with a good reproductive safety profile.
While we worry so much about exposing the fetus to medications, it is important to remember that untreated depression in the mother obviously places the mother at risk but may also have a negative impact on the developing child. Recent studies indicate that women who are depressed during pregnancy are more likely to give birth to infants that have a lower birthweight, smaller head circumference and lower APGAR scores, which are all negative indicators of well being in the newborn. In other words, avoiding medication use during pregnancy is not always the safest option.
Ruta Nonacs, MD PhD