Latest Study Suggests Lexapro et al Carry No Benefit For Pregnant Women and Babies

Boston, MAWhile experts agree that attempting a thorough clinical trial into SSRI antidepressants on pregnant women is ethically questionable, researchers continue to search for answers to a long-debated question: are depression patients who become pregnant better off without their antidepressants in an attempt to avoid the possibility of Lexapro birth defects?

Lexapro (escitalopram) is part of a class of antidepressants known as Selective Serotonin Reuptake Inhibitors (SSRI). They have grown to become the most commonly prescribed medication in the US for patients between 18 and 44, an age considered childbearing age for most women. Antidepressant use has risen 400 percent since 1992.

This growth served as the genesis for the latest study, performed by researchers based in Boston and nested in data from previously released studies. Lexapro was included in the study, given that it is a member of the SSRI class and there are concerns over Lexapro side effects.

According to a report from CBS News (10/31/12), researchers came away with two primary conclusions based on their findings. Study author Dr. Adam Urato, chairman of obstetrics and gynecology at MetroWest Medical Center and a maternal-fetal medicine specialist at Tufts Medical Center, maintained there was "clear and concerning" evidence of worsened pregnancy outcomes associated with SSRI use.

Urato and his research colleagues also concluded there was no evidence of benefit for pregnant women and their offspring. And while Urato and colleagues are being criticized by SSRI advocates for fear mongering, the researchers maintain the goal of their study was never to convince women to avoid SSRI drugs.

"The goal is to given them information so they can make the right decision for them," Urato is reported to have told HealthDay.

In the study, birth defects were more closely associated with Paxil, an antidepressant in the SSRI class manufactured by GlaxoSmithKline. Nonetheless, Lexapro has been associated with the potential for newborn birth defects such as persistent pulmonary hypertension.

The US Food and Drug Administration (FDA) has classed Lexapro as a Pregnancy Category C medication. That means there is a risk, but in the absence of adequate human studies, it is difficult to quantify that risk. While there is a chance of harm to the fetus, the benefits may outweigh the risk and thus Lexapro can be prescribed during pregnancy.

But not without some concern, according to this latest research. The study authors found evidence that pregnant women taking SSRI antidepressants translated to an increase in miscarriage, as well as pregnancy-induced hypertension and preeclampsia, especially if used beyond the first trimester.

Infants exposed to antidepressants in the womb were found to be 30 percent more likely to have Newborn Behavioral Syndrome, a condition characterized by persistent crying, jitteriness and feeding difficulties and in rare cases, seizures and breathing problems. Autism spectrum disorder was identified as another concern, as is the potential for stroke in the mother.

The most pressing finding, which encompassed Lexapro side effects, was the potential for premature birth??"a complication identified in more than 30 of the previously published studies the authors reviewed. "This is a significant finding," Urato said, "because we know that babies born before 37 weeks are at risk for many short and long-term health problems."

Lexapro pph has been identified as a potential birth defect in rare cases.

The researchers reviewed previous studies in which half of study participants took an SSRI, while the others took a placebo, according to USA Today (10/31/12)

Critics were quick to pounce on the study's conclusions. Kimberly Yonkers, a professor of psychiatry, obstetrics and gynecology at Yale University who served on a 2009 panel tasked with creating depression treatment guidelines for pregnant women, said in a statement that the study conclusions were "nonsense. I would say the authors of this article went overboard in terms of their negativity."

Yonkers did, however, agree with Urato and fellow researcher Dr. Alice Domar, OB/GYN at Beth Israel Deaconess Medical Center, that pregnant women with mild, to moderate depression may be in a position to successfully wean from SSRI antidepressants to lessen the risk to a fetus. She also said that a mother's depression is not inherently bad for the fetus, according to the USA Todayreport.

The study, published this past fall in Human Reproduction (10/31/12), favors psychotherapy and other forms of treatment where appropriate, over SSRI use in an effort to avoid problems suggested by Lexapro birth defects.