Two studies published in the New England Journal of Medicine in June 2007 reported on the risks of birth defects when women took selective serotonin-reuptake inhibitors (SSRIs) during pregnancy (sources: Louik, C et. al NEJM Volume 356:2675-2683 June 28, 2007 Number 26 and Alwan S. et al. NEJM Volume 356:2684-2692 June 28, 2007 Number 26). Both articles conclude that SSRIs taken during the first trimester of pregnancy increase the risk of certain birth defects, but the increased risk was considered to be small. Given that untreated depression carries its own risks to the unborn baby, the researchers were said to have considered these finding reassuring in terms of weighing the risks and benefits of treating depressed women during pregnancy.
Further analysis of their data showed that women with a body mass index of 30 and greater showed an even further increase in risk defects. For example, obesity plus SSRI use resulted in 3.5 times greater chance of certain heart defects and 5.9 greater chance of certain cranial defects. These numbers were in comparison to non-obese women taking SSRIs.
We don’t know why having more body fat makes a difference, but we do know SSRIs are absorbed more quickly in fat. Thus, it would stand to reason that perhaps more drug is absorbed and/or retained and this may amplify the effects of the drugs.
Women taking antidepressants and considering getting pregnant should consult with their doctor about whether to continue on the medication during pregnancy.
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