Psychiatric Drugs During Pregnancy: Benefits, Risks, Alternatives

Taking medications during pregnancy — both prescription and over−the−counter — can be dangerous for the developing fetus. Drugs can cause a variety of unwanted effects including premature birth, abnormal birth weight, physical defects, developmental and neurological abnormalities, and others. But many pregnant women have conditions that are important to treat, so doctors and patients must weigh the risks of using medications against the risks to the mother and fetus of not treating the mother effectively. Some recent studies looked at the effects of antidepressant and anti−anxiety drugs as well as the alternative therapy, acupuncture.

Early on, when organs such as the heart, lungs, kidneys, and nervous systems are forming, a drug may have a different effect than later when overall growth, rather than the development of basic organs and structures, is the primary process.

The risk medications pose is often related to the trimester during which they are used. Early on, when organs such as the heart, lungs, kidneys, and nervous systems are forming, a drug may have a different effect than later when overall growth, rather than the development of basic organs and structures, is the primary process. Similarly, the dose of medication and the length of time that the fetus is exposed can both alter the risk. Information about the risk/benefit balance of drugs is gathered through testing on animal models and extensive patient monitoring and is available through the Federal Drug Administration, the National Institute of Health, and many medical websites.(1)

Because many people now use antidepressants, a recent study examined the effects of medications prescribed to treat depression and anxiety when used during pregnancy. Researchers were specifically concerned about the impact of these medications on the risk of preterm birth which is associated with many newborn problems from early breathing difficulties to later neurodevelopmental abnormalities and even, increased risk of death in the newborn period.(2) In the United States, about 8 % of pregnant women take antidepressants.(3) Often these are selective serotonin reuptake inhibitors (SSRI), such a Prozac, Paxil, Zoloft and Lexapro and selective serotonin and norepinephrine reuptake inhibitors (SNRI) such as Effexor. This group of medications can also be used to treat anxiety as can another category of medications, benzodiazepines, which include the tranquilizers Ativan, Xanax and Valium.

The investigators studied 2793 pregnant women and collected social, economic, demographic, and medical information about them. They followed them through their pregnancies and deliveries and noted their medication use, including psychiatric drugs, and any pregnancy/delivery complications. They also evaluated the newborns and checked their length of gestation, birth weights, APGAR scores (immediate assessment of newborn's condition following birth), need for treatment in neonatal ICU, and histories of problems with respiration.

About 23% of the women taking psychiatric medications had a preterm (before 37 weeks gestation) delivery, while only about 9% of the women who did not use these medications delivered early.

About one out of ten of the mothers in the study took psychiatric medications during pregnancy. Three−quarters of those women took only one medication, with another 25% taking two or three medicines. About 23% of the women taking psychiatric medications had a preterm (before 37 weeks gestation) delivery, while only about 9% of the women who did not use these medications delivered early. As the number of medications taken by the women in the study increased, so did the risk of preterm delivery.

Interestingly, the risk of preterm delivery associated with SSRI/SNRI use only occurred if the medication was started in the second or third trimester. If the mothers started the drug either before pregnancy or in the first trimester and continued it throughout the pregnancy, there was no increased risk of preterm birth. The study data suggested that every SSRI and SNRI might not carry the same risk of preterm delivery. But the study population was too small to draw definitive conclusions about which among these drugs were more or less risky.