What birth defects are associated with SSRIs?

The most common birth defects are heart defects, cleft lip and cleft palate, Down syndrome and spina bifida.

SSRIs are not considered major teratogens. However, they cross the placenta and may affect your newborn. Zoloft and Paxil and the SSRI as a group have been associated with congenital malformations, particularly septal defects.

PPHN / persistent pulmonary hypertension of the newborn

A recently published case-control study has shown that infants born to mothers who took SSRIs after the 20th week of pregnancy were six times more likely to have persistent pulmonary hypertension (PPHN) than infants born to mothers who did not take antidepressants during pregnancy. PPHN is a life-threatening disorder in which the newborn’s arteries to the lungs remain constricted after delivery, limiting the amount of blood flow to the lungs and therefore the amount of oxygen into the bloodstream.

The background risk of a woman giving birth to an infant affected by PPHN in the general population is estimated to be about 1 to 2 infants per 1,000 live births. Neonatal PPHN is associated with significant morbidity and mortality.

SSRIs brands that affect PPHN include Celexa, Fluvoxamine, Lexapro, Paxil, Prozac, Symbyax, and Zoloft.

Congenital heart defects, ASD, VSD
The Food and Drug Administration (FDA) has determined that exposure to paroxetine, Paxil, Paxil CR, and Pexeva in the first trimester of pregnancy may increase the risk for congenital malformations, particularly cardiac malformations. At the FDA’s request, the manufacturer GlaxoSmithKline changed Paxil’s pregnancy category from C to D and added new data and recommendations to the “Warnings” section of the prescribing information.

Most of the cardiac defects observed in these studies were atrial septal defects (ASD) or ventricular septal defects (VSD), conditions in which the wall between the right and left sides of the heart is not completely developed.

Wellbutrin, a popular antidepressant, has been linked to heart-related birth defects for women who took the drug one month prior to getting pregnant and during the first trimester of pregnancy.

Cleft palate and cleft lip
There was also a notable rise in facial malformations such as cleft lip and palate. A cleft is a gap resulting from an incomplete closing of a structure during development. Clefts that occur in the lip and palate or roof of the mouth are called oral-facial clefts. Some babies only have a cleft lip. Many babies who have cleft lip also have a cleft palate. Cleft palate also can occur without cleft lip.

Omphalocele
Omphalocele is a congenital defect in the abdominal wall in which variable amounts of abdominal contents protrude into the base of the umbilical cord. Until about week 10 of pregnancy, it is normal for the bowel to be outside of the baby’s belly.  After 10 weeks the bowel or intestines should be inside the belly.

According to the Centers for Disease Control and Prevention (CDC) about 775 babies in the United States are born with an omphalocele per year.

One of the causes of omphalocele is taking SSRIs during pregnancy. Some brands of SSRIs include Paxil, Prozac, Zoloft, Lexapro, Celexa, Asentra.

What are alternative drugs and treatments? Are there safer drugs?

Because of the concern for SSRIs and birth defects, guidelines were released last year by the American Psychiatric Association and the American College of Obstetricians and Gynecologists stating that psychotherapy may be an effective alternative to antidepressants for pregnant women with mild to moderate depression.

However, the guidelines say, women with a history of more severe depression, or other major psychiatric disorders, may need to continue with their medication.

Also while antidepressants may be covered by health insurance, psychotherapy or psychiatry is usually not.

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For pregnant women who are taking SSRI drugs during their third trimester, doctors must consider the potential risks and benefits of treatment to both mother and child, perhaps tapering the dosage during the third trimester.

Were you advised of the birth defect risks? Has your baby suffered serious heart defects regard PPHN?

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