January 1, 1970 · FLEMING | NOLEN | JEZ, L.L.P.
Selective Serotonin Reuptake Inhibitors (SSRIs) are a class of drugs and related medications often prescribed for depression, anxiety, panic, obsessive-compulsive, “pre-menstrual dysphoric” and “social anxiety” disorder. But what is an SSRI and what does it do, especially when taken during pregnancy?
SSRIs work to prevent absorption of serotonin. Serotonin is a chemical in the body that works in the central nervous system as well as peripheral nervous system. This chemical works as a messenger throughout the body and is found in areas such as the brain, walls of blood vessels and platelets. Serotonin is normally released into the space between the nerve cells and is then either reabsorbed or destroyed. SSRIs work against this reabsorption causing the serotonin to be built up in the space between nerve cells.
When a woman takes SSRIs and becomes pregnant, the SSRI may affect the baby. Recent studies show how a mother who takes SSRIs during pregnancy can be harmful to the baby. These birth defects can be problems with the baby’s heart, brain, skull, abdomen or even spinal cord.
In 2006, the New England Journal of Medicine published that there is an association between the mother’s use of SSRIs late in pregnancy and the baby being born with primary pulmonary hypertension of the newborn (PPHN).1This condition is not diagnosed when the child is still in the womb as when the baby is in the womb, he or she relies on the mother for oxygen. However, when the baby is born, the child can no longer rely on the mother for breathing. When a baby is born with PPHN, they are not able to breath properly on their own. The blood pressure to the lungs is not correct, so when the baby takes his or her first breaths, “the pressure in the lungs remains high” “allowing blood to be directed away from the lungs.”2 This can be a life-threatening condition for the baby.
Other studies have shown that the baby may be born with a heart defect.34567 These defects include atrial septal defect, ventricular septal defect, coarctation of the aorta, hypoplastic left heart, pulmonary artery stenosis, and a right ventricular or left ventricular outflow tract obstruction. In addition, the baby may be born with omphalocele, which means that the baby’s intestines or other abdominal organs stick out through the baby’s bellybutton, or a neural tube defect, such as spina bifida or meningocele. The child may also be born with craniosynostosis, which means that the sutures often known as soft spot on the child’s head are closed or fused prematurely. The baby may even suffer from a limb defect, such as a club foot.
A child may be born with defects if the mother knowingly or unknowingly takes SSRIs during pregnancy. These problems may be life-threatening, result in additional hospitalizations and even surgery.
1 Chambers, C.,Selective Serotonin-Reuptake Inhibitors and Risk of Persistent Pulmonary Hypertension of the Newborn. N Engl J Med 2006;354:579-87.
3 Kornum,Use of selective serotonin-reuptake inhibitors during early pregnancy and risk of congenital malformations: updated analysis. Clinical Epidemiology 2010; 2:29-36.
4 Pedersen,Selective serotonin reuptake inhibitors in pregnancy and congenital malformations: population based cohort study. BMJ 2009; 339:1-6.
5 Merlob,Are selective serotonin reuptake inhibitors cardiac teratogens? Echocardiopharic screening of newborns with persistent heart murmur. Birth Defects Research Part A 2009.
6 Diav-Citrin,Paroxetine and fluoxetine in pregnancy: a prospective, multicentre, controlled, observational study. British J Clin Pharm 2008; 66(5):695-705.
7 Louik,First-Trimester Use of Selective Serotonin-Reuptake Inhibitors and the Risk of Birth Defects. N Engl J. Med 2007; 356:2675-83.