This is an archived article that was published on sltrib.com in 2012, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
Given recent news coverage about the use of antidepressants during pregnancy and the possible links to birth defects, I feel an obligation to families and care providers to respond to this concern.
As the medical director of the Pregnancy Risk Line, I have noted a remarkable increase in the number of calls from worried mothers, their family members and health care providers about antidepressant use during pregnancy and while breast-feeding.
Every pregnant woman has about a 3 percent chance of having a child with a birth defect, no matter what she may or may not take during the pregnancy. We refer to this as "background risk."
Along with many other reproductive risk education and research centers across the United States, Canada and Europe, we at the PRL have found, from evaluation of the published studies, that the increased risk for birth defects from use of antidepressants during pregnancy is low and, for most defects, no higher than the background risk.
The PRL, Utah's reproductive education center, focuses on the effects of drugs and other exposures on a developing fetus and breast-fed baby. More than 20 percent of all calls to the PRL are regarding medications taken for mental health needs. These include drugs used for depression, anxiety and bipolar disorders.
Many of these callers report going "cold turkey" off needed medications or not starting a necessary medicine because they have heard these drugs may cause birth defects. However, the risk of leaving depression untreated in pregnant women and new mothers could far outweigh any potential negative side effects from antidepressant use. A growing body of literature suggests a high risk of adverse effects from untreated depression.
Thoughts of suicide, suicide attempts and an increased risk for postpartum depression are just some of the potential effects of not treating depression. Other studies also indicate an association with adverse pregnancy outcomes such as miscarriage, small head, a need for special newborn care, low birth weight and prematurity.
There is an axiom often used in obstetrics that "the healthier the mother, the healthier the baby." This has been seen with many chronic medical conditions and is being borne out by studies of mental health conditions as well.
Before stopping a needed medicine, before or during a pregnancy, or before stopping breast-feeding, a woman should always talk with the prescriber of the drug and with her prenatal care and primary provider. There is usually no need to discontinue a medicine that is working well to treat a medical condition, including mental health conditions.
We encourage those with questions to call the PRL for evidence-based answers. The PRL is a free service for Utah families and health care providers and has been answering questions about the effects of medicines, chemicals and other maternal exposures on a developing fetus or breast-fed baby for nearly 30 years.
For more information about drugs during pregnancy and breast-feeding, please contact the Pregnancy Risk Line at 800-822-2229 (BABY).
John C. Carey, a pediatrician and clinical geneticist, has been practicing in Utah for 32 years and is one of the founders of the Pregnancy Risk Line, a joint project of the Utah Department of Health and the University of Utah's Division of Medical Genetics in the Department of Pediatrics.