SSRI Heart Birth Defects

Serious heart defects are among the increased health risks to a baby en utero for pregnant women taking selective serotonin reuptake inhibitors (SSRI’s) for anxiety and depression, studies show. Despite their tremendous popularity—Zoloft, Celexa, Lexapro, Paxil and Prozac are the most widely prescribed antidepressants on the market today—SSRI’s pose a heightened risk of heart defects to babies exposed to the drugs during pregnancy.

Heart malformations, spina bifida, and persistent hypertension in newborns (PPHN) are a few of the congenital defects increasingly linked to SSRI’s.

The use of SSRI’s has increased by 400 percent over the past two decades, with drugs like Paxil and Zoloft enjoying the most popularity among patients between the ages of 18 and 44 (and women in their childbearing years).

With the exception of the Class D drug Paxil (paroxetine), Zoloft, Celexa, Prozac and Lexapro continue to be commonly prescribed to pregnant women—despite findings in several medical journals, clinical trials showing SSRI birth defects in animals and safety communications issued by the Food and Drug Administration (FDA).

FDA warnings about SSRI heart defects

In 2005 the FDA warned of increased risks of congenital heart defects linked to Paxil, stating that “new studies for Paxil suggest that the drug increases the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy.”

Research confirmed this claim, suggesting Paxil doubles the risk for heart defects that other SSRI’s pose. As a result of these findings, the drug maker GlaxoSmithKline was required to change its pregnancy warning label from a “C,” meaning risks of defects in pregnancy were yet unknown, to a “D,” establishing a known risk of birth defects.

The next year the FDA issued another warning regarding the potential hazards of antidepressants in pregnancy—this time with respect to the neonatal syndrome known as “persistent hypertension” in newborns, or PPHN. PPHN is a condition that results when a newborn baby’s blood does not go to the lungs and, in turn, to the rest of the body, as it should upon delivery.

Medical studies on SSRIs and fetal heart defects

A 2009 study found that among nearly half a million Danish children born between 1996 and 2003, the risk of heart defects was elevated among those whose mothers had used SSRIs such as fluoxetine (Prozac), sertraline (Zoloft) and citalopram (Celexa) during early pregnancy. The same study found that overall, SSRI use in early pregnancy (defined as 28 days before conception to 112 days after conception) doubled the risk of a particular kind of heart defect involving the tissue that separates parts of the heart.

Septal heart defects are a malformation of the wall that divides the left chamber of the heart from the right chamber of the heart, causing a decrease in the body’s ability to circulate oxygen-rich blood, and may require surgical repair. Zoloft (or sertraline) more than tripled this risk, while Celexa (citalopram) more than doubled it; and using more than one SSRI quintupled the risk of the heart defect.

Researchers were quick to clarify that the overall number of children born with such defects in the SSRI-taking group remained small, even if significantly larger in comparison to the non-SSRI-taking group tested. For about every 250 pregnant women taking SSRI’s, two infants were born with the defect, as opposed to one out of 250 women not taking SSRI’s. In a group of 200 mothers taking more than one SSRI, the number increased to four defects.

In an accompanying editorial, Dr. Christina Chambers, of the University of California, San Diego, said doctors and patients “need to balance the small risks associated with SSRI’s against those associated with undertreatment or no treatment.”

Risks of antidepressants during pregnancy

In a similar vein, other researchers have urged women taking SSRI’s not to discontinue use based on these findings, cautioning that the risk of heart defect is greater with SSRI’s but not so much greater that their use should be discontinued entirely. It is possible that in some cases the risks of untreated depression to mother and child outweigh the risks of birth defects; and, by blocking a receptor in the brain that absorbs the mood-influencing chemical serotonin, SSRI’s have helped millions of Americans who suffer from anxiety and depression.

Still, such findings and others—like the results of a recent study of the antidepressant Wellbutrin published in the American Journal of Obstetrics & Gynecology, showing an increased risk of a narrowing of the heart’s main artery or aorta, and in turn a need for surgical repair—shed light on the heightened risks posed by antidepressants in pregnancy.

Patients and their doctors will therefore do well to weigh with care the overall risks and benefits of taking an SSRI or antidepressant during pregnancy.

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