Pregnancy, Psychiatric Diagnosis & Drugs, Health Effects on Mother and Fetus
Expecting a child is one of the most monumental moments in a woman's life. There can be a great deal of joy and many questions and concerns that arise, too, for every woman. Struggling with emotional issues or being on psychiatric drugs adds further complications. We will be adding information about some of these issues on this page.
"there is significant prescribing of drugs known to be associated with fetal risks, with 1-4% of women being prescribed medicines considered contraindicated and a larger proportion prescribed medicines where information pon safety in pregnancy is incomplete....the delay between conception and recognition of pregnancy increases the risk of continuing exposure in early pregnancy, a critical period for fetal organ formation, to medicines prescribed for chronic conditions."
Does Antidepressant Use Attenuate the Risk of a Major Depressive Episode in Pregnancy? Kimberly A. Yonkers, et al; Epidemiology, November 2011
Failure to use or discontinuation of antidepressants in pregnancy did not have a strong effect on the development of a major depressive episode.
Antidepressants and Pregnancy: Continued Evidence of Harm-Still No Evidence of Benefit, Adam C. Urato, MD, Tufts University School of Mediclne, Boston, MA, Ethical Human Psychology and Psychiatry, Vol 13, Number 3, 2011
"Antidepressant medication use during pregnancy is increasing. It is essential that women
of childbearing age, pregnant women, and their health care providers be aware of the risks,
benefits, and alternatives prior to taking these agents. The best available evidence suggests that antidepressant use by pregnant women may be associated with miscarriage, birth defects, preterm birth, decreased birrh weight, neonatal behavioral syndrome, persistent pulmonary hypertension in the newborn, neonatal electrocardiogram (EKG) changes, and behavioral effects. Evidence of benefit is lacking. The hope that improved maternal mood through medication would lead to better pregnancy results has not been realized; the antidepressant-exposed pregnancies are faring worse. The available evidence raises the question: Are we exposing a generation of women and their babies to drugs that are causing significantly more harm than good?" Read study here.
Maternal Use of Selective Serotonin Reuptake Inhibitors, Fetal Growth, and Risk of Adverse Birth Outcomes, Hanan El Marroun, et al, Archives of General Psychiatry, July 2012
SSRIs, cannabis or tobacco prenatal exposure all negatively affected growth of fetal head circumference...."Serotonin is known to play an important role in prenatal brain development, and manipulation of serotonin levels with SSRIs in utero may directly affect fetal brain growth. Pharmacological animal studies demonstrated decreased brain maturation; animals exposed to SSRIs had fewer dendritic branches, shorter dendritic length, and a smaller dendritic field in the somatosensory barrel cortex. Also, Rayburn et al demonstrated that newborn mice exposed to paroxetine were more likely to have narrower heads. In that study, therapeutic doses were used to mimic the human levels in the fetal mouse brain."
"Antenatal Use of Selective Serotonin-Reuptake Inhibitors and QT Interval Prolongation in Newborns" G. Dubnov-Raz et al, Pediatrics 2008
"Prolongation of the QT intervial is a risk factor for sudden death....Mean QTc was significantly longer in the group of newborns exposed to antidepressants as compared to control subjects....
"Disturbed development of the eneteric nervous system after in utero exposure of selective serotonin re-uptake inhibitors and tricyclic antidepressants. Part 1: Literature review" C. Nijenhuis, et al, British Journal of Clinical Pharmacology, August 2011
The gastrointestinal tract of child is affected by exposure in utero to antidepressants
"In utero exposure to antidepressants and the use of drugs for pulmonary diseases in children" by P. G. J. ter Horst et al, Eur J Clin Pharmacol July 2012
"In utero exposure to SSRIs leads to a statistically significant increase in the use of drugs for pulmonary diseases..."
"Selective serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: population based cohort study from the five Nordic countries" by Kieler et al, BMJ 2012
"Conclusions: The risk of persistent pulmonary hypertension of the newborn is low, but use of SSRIs in late pregnancy increases that risk by more than twofold. The increased risk seems to be a class effect."
Pregnant Mothers Should Not Take SSRI Antidepressants, Peter R. Breggin, MD and Ginger Breggin Posted: 07/21/07 10:36 PM ET Huffington Post
In the CDC study, several severe birth defects were doubled or nearly tripled in frequency when SSRIs were taken in the first trimester. This combined with the other known toxic effects of SSRIs, including brain damage and dysfunction, make these drugs contraindicated in pregnancy.
SSRI antidepressant use by pregnant mothers in the first trimester of pregnancy have been shown to have previously unidentified links to three birth defects in two new studies reported in the New England Journal of Medicine. One study was associated with the Centers for Disease Control and Prevention (CDC) (Alwan et al., 2007) and the other with Boston University (Louik et al., 2007).
The study led by Sura Alwan and colleagues involving the CDC showed the following: "Anencephaly--birth without a forebrain--showed a 2.4 times greater occurrence in women who had taken SSRIs in the first trimester." This is a catastrophic, fatal birth defect that is not correctable.
The study examined histories of 9622 cases of birth defects and 4092 controls who were infants born without birth defects. Some stillbirths (occurring at 20+ weeks gestation) were included but if anencephaly resulted in a spontaneous miscarriage or a planned abortion, these events would not appear in this study's findings. Read more here.
Exposure to SSRI Antidepressants In Utero Causes Birth Defects, Neonatal Withdrawal Symptoms, and Brain Damage, Peter R. Breggin MD, Ginger Breggin, International Journal of Risk & Safety in Medicine 19 (2007)203–207
Pregnant mothers should avoid taking SSRI antidepressants—they are hazardous to the developing fetus, cause withdrawal symptoms in the newborn baby, and induce biochemical and morphological abnormalities in the brain. If pregnant mothers need help with sad or anxious feelings, they should seek counseling or psychotherapy, especially family therapy involving the child’s father, as well as other sources of emotional support.
"Selective Serotonin Reuptake Inhibitors and Risk for Major Congenital Anomalies" Malm, Heli MD, PhD et al. Obstetrics & Gynecology: July 2011 - Volume 118 - Issue 1 - pp 111-120
the study authors state: "Fluoxetine use is associated with an increased risk of isolated ventricular septal defects and paroxetine is associated with right ventricular outflow tract defects. The absolute risk for these specific cardiac anomalies is small but should guide clinicians not to consider fluoxetine or paroxetine the first option when prescribing selective serotonin reuptake inhibitors to women planning pregnancy. Special attention should be given to alcohol use in pregnant women using selective serotonin reuptake inhibitors."
As we have said in our paper: Pregnant mothers should avoid taking SSRI antidepressants—they are hazardous to the developing fetus, cause withdrawal symptoms in the newborn baby, and induce biochemical and morphological abnormalities in the brain. If pregnant mothers need help with sad or anxious feelings, they should seek counseling or psychotherapy, especially family therapy involving the child’s father, as well as other sources of emotional support. We urge pregnant women to seek non-drug support from therapy, family and other psychosocial help during pregnancy so their unborn child is not exposed to these substances.
The potential risks of commonly prescribed antipsychotics: during pregnancy and lactation.
Iqbal MM, Aneja A, Rahman A, Megna J, Freemont W, Shiplo M, Nihilani N, Lee K., Psychiatry August 2005
Dr. Iqbal is Clinical Director, Central New York Psychiatric Center, Auburn Satellite Mental Health Unit, New York, Clinical Assistant Professor, Department of Psychiatry at SUNY Upstate Medical University, Syracuse, New York.
Abstract: Chlorpromazine, haloperidol, fluphenazine, clozapine, risperidone, quetiapine, olanzapine, ziprasidone, and aripiprazole are antipsychotics commonly used in psychiatric medicine. Approximately one third of pregnant women with psychotic symptoms use antipsychotics at least once. This review will discuss the effects of antipsychotic use during pregnancy and lactation on the fetus and infant.Although adequate and well-controlled studies have not been done in any one of these antipsychotic drugs, animal studies have revealed evidence of teratogenic or embryo/fetotoxic effects in all of them. Toxicities include skeletal malformations, central nervous system (CNS) defects, cleft palate, cardiac abnormalities, decreased fetal growth, and fetal death. For example, in pregnant women, congenital malformations and perinatal death have been reported with chlorpromazine use. Both chlorpromazine and fluphenazine in monotherapy have been shown to cause extrapyramidal symptoms and respiratory distress in infants born to mothers treated with these medications. Haloperidol use during pregnancy has been linked to severe limb reduction defects.Effects of antipsychotic use in lactating mothers are mostly unknown. However, the use of chlorpromazine has been reported to result in drowsiness and lethargy in breastfed infants. Additionally, clozapine has been reported to cause sedation, decreased suckling, restlessness, irritability, seizures, and cardiovascular instability of infants were also reported with clozapine use in lactating mother. Use of antipsychotic drugs by pregnant and lactating mother may only be justified if the potential benefit outweighs the potential risk to the fetus.
"Antipsychotics During Pregnancy--Relation to Fetal and Maternal Metabolic Effects" Robert Bodén, MD, PhD, Arch Gen Psychiatry, July 2012. Antipsychotics during pregnancy increase health risks for mother and child: A new study links antipsychotic drugs used in pregnancy to gestational diabetes. The study, published in the journal Archives of General Psychiatry, July 2012, was based on an examination of medical records of Swedish people. Records of hundreds of thousands of women who gave birth in Sweden between 2005 and 2009 provided the information.
"Maternal use of antipsychotics during pregnancy ... is associated with an increased risk of gestational diabetes," the authors wrote. "Pregnant women treated with antipsychotics should be closely monitored for gestational diabetes and deviating fetal growth."
For those women and young families considering tapering off their psychiatric drugs, Dr. Peter Breggin's new book: Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and Their Families offers a new person-centered approach and a wealth of information on how to maximize success..