Birth Defects and SSRIs –A Game of Russian Roulette

Fresno, CAThe number of women who have given birth to babies suffering from respiratory problems, persistent pulmonary hypertension (PPHN), heart defects, seizures, SSRI withdrawal symptoms, and other possibly SSRI related birth defects is not known. However, the effect is measurable and devastating for moms and babies alike.

Many women were told by their health care professionals, who very likely were not aware of any problems, that taking their selective serotonin reuptake inhibitor (SSRI) antidepressant medication while pregnant shouldn't pose a risk to their babies. But there is a risk--a possibility that all may not turn out well. Many women who decided to continue their medication thought they were making educated decisions, and had sought, correctly, proper medical advice. But it's a game of Russian roulette when you don't have all the facts. And the facts are still emerging.

SSRI Birth Defects - The Anecdotal Evidence

The anecdotal evidence suggests that SSRI birth defects can be far worse than women may be led to believe. Sheila, [not real name pending a lawsuit] for example, remained on her SSRI medication while pregnant on the advice of her physician, and gave birth to a baby girl with holes in her heart and anal atresia defect – a defect with the anus.
And there are women who have given birth to babies with transposition of the great arteries-- or TGA--which means the blood vessels that take blood away from the heart to the lungs and the body are switched around. Heart defects often require surgery, and drug therapy, all of which is stressful to the infant, and parents, not to mention expensive. Worse case, however, is when the baby does not survive, dying after just a few weeks or months of life.

Another commonality appears to be babies experiencing tremors and seizures immediately after being born – what are believed to be SSRI withdrawal symptoms. In these cases the infants are taken to natal intensive care units for monitoring and to be medically treated for withdrawal. Many also experience breathing difficulties and are put on oxygen and breathing machines for weeks in many cases.

Some parents have noticed that their children have learning disabilities, which don't manifest until they are several years old. Autism is one of the common themes, although there is no hard evidence as yet to link it with SSRI use in pregnancy.
Some babies don't make it to term, and there have been reports of babies' internal organs developing outside their stomach. Take Joanne's (not her real name pending a lawsuit] case. Her daughter was born prematurely, weighing just less than 5lbs. Her baby daughter had a herniated stomach, and was not breathing. So, her daughter she was hospitalized for 21days. She is now developmentally delayed and has a weak immune system.

SSRI Birth Defects – The Published Studies

The published studies so far, and they are few, highlight the risk for PPHN. In 2006 the Food and Drug Administration ordered manufacturers of SSRIs and SNRIs – a closely related class of medication - to carry warnings on their labels about the risk for PPHN. This was based on a public health advisory issued early that year which stated:
"A recently published case-control study has shown that infants born to mothers who took selective serotonin reuptake inhibitors (SSRI's) after the 20th week of pregnancy were 6 times more likely to have persistent pulmonary hypertension (PPHN) than infants born to mothers who did not take antidepressants during pregnancy."
Antidepressants known as SSRIs include Paxil marketed by GlaxoSmithKline, Prozac by Eli Lilly, Zoloft by Pfizer, and Celexa and Lexapro sold by Forest Laboratories, along with various generic versions of the drugs. The closely-related class of SNRI antidepressants also carry birth defects warnings and include Wyeth's Effexor and Lilly's Cymbalta.

However, while these warnings may prove helpful to some, it would appear that the message by and large does not seem to be reaching women. A study of 500,000 women, published in the Annals of Internal Medicine in 2007, found that 50 percent of women taking a prescription drug during pregnancy were not aware that those drugs could cause birth defects, because they had not been warned about getting pregnant while on the drugs.

Importantly, the investigators noted that women being prescribed drugs like SSRIs should be counselled about the risks before they begin taking the drugs. Good advice indeed, but for women who are not warned, or were not aware of the risks and who give birth to babies with SSRI birth defects, a lawsuit may be the only way to ensure that their friends or their sisters don't have the same experience.