Nashville, TNOn the surface it's an alarming finding, and while other factors may be at play the concern remains that for each SSRI prescription an expectant mom fills during the second trimester of her pregnancy, her odds of going into premature labor can double. Such is this latest concern over Paxil side effects—a popular antidepressant in the class identified as selective serotonin reuptake inhibitors (SSRI).
SSRI antidepressants belong to a latter class of those drugs—and there has been concern for some time over the potential for Paxil birth defects: among them, Paxil heart defects and persistent pulmonary hypertension of the newborn (PPHN). While those adverse reactions are rare, they have allegedly occurred and are the subject of many a Paxil lawsuit.
Now, according to a Reuters Health report (5/30/12), a major US study appears to have found a connection between SSRI drugs and premature labor—especially amongst expectant mothers who continue to use an SSRI antidepressant such as Paxil throughout her second trimester. Admittedly, the age of the mother and smoking during pregnancy are factors that can cloud the issue, but concern remains nonetheless. The study, based on nearly 229,000 infants, found that when mothers filled two or three antidepressant prescriptions during the second trimester, their babies stayed in the womb for four to five fewer days, on average than other babies. Overall, almost 27 percent of women amongst the study group went into early labor.
The statistic for actual pre-term delivery was lower, at 14 percent.
The study, conducted at the Vanderbilt University School of Medicine in Nashville, also found that newborns were more likely to experience a seizure if the mother used an SSRI drug such as Paxil during the third trimester.
A researcher in the study, Dr. Richard C. Shelton is a professor at the University of Alabama at Birmingham. While disclosing he has performed paid consulting work in the past involving antidepressants for various manufacturers, none of the other researchers in the study had any conflicts and thus were in a position to approach the study without bias.
Shelton also told Reuters Health that stopping antidepressants during pregnancy is the safest bet, if at all possible. The decision should be one taken in concert with a family physician conversant with the patient's nature and degree of depression. Shelton noted that depression itself can be a pregnancy risk in some cases, thus such decisions must be made according to an individual's unique case and needs.
The resulting debate that surrounds which is the lesser of the two evils—depression itself, or continuing to take an SSRI antidepressant like Paxil throughout a pregnancy and risk Paxil birth defects—doesn't take away from the potential for concern.
The findings were based on 228,876 Tennessee women who gave birth between 1995 and 2007. All were on Medicaid. Overall 23,280 women had been on an antidepressant before pregnancy. Most—75 percent—stopped taking the drugs before their second trimester. Women who were still on antidepressants during the second trimester were seen to commence labor earlier. The findings were published in the American Journal of Obstetrics & Gynecology.
As with all drugs, the US Food and Drug Administration (FDA) takes the position that a drug is considered safe if its' benefits outweigh the risks. Depression is a constantly growing problem, for which there are a variety of medicinal treatment options. But while depression itself can impact an infant, the risk for adverse reactions from the mother's use of SSRI antidepressants during pregnancy remains. And the risk for Paxil defects of the newborn combines to a very real, if rare threat.
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