Is Your Antidepressant Safe During Pregnancy? Here's What to Know

As many as one in four moms-to-be have a mental health disorder. Here's what to know about pregnancy-safe medications

Taking any sort of medication during pregnancy has always made moms-to-be nervous, but in recent years a whole new category of concern has exploded: Is it safe to take a prescription to treat a mental health issue, such as an antidepressant, SSRI (selective serotonin reuptake inhibitors) or anti-anxiety medication? If you're one of the one in four women today who have a mental health disorder during pregnancy, here are five important things to know, according to the March of Dimes.  

1. You’re not alone. You may not need to stop your medication just because you're pregnant.  “It’s important to balance the possible risks and benefits of all medications to the mother and the baby,” emphasizes Kimberly A. Yonkers, M.D., director of the PMS and Perinatal Psychiatric Research Program at Yale University School of Medicine in New Haven, CT. Talk to your doctor who can help you look into the safety of your current meds and help you determine whether an alternative would be safer.

2. The research so far has not been definitive. It's easy to read the news (and freak out!) about the risks of medications in pregnancy, but it's important to consider all the research that's been done. For example, the same number of studies showed no increased risk of having a baby with a birth defect from taking SSRIs as did those that found a higher rate. And many other factors can come into play: Women who take antidepressants are more likely to drink and smoke cigarettes while pregnant,  according to Dr. Yonkers, and both of these habits can harm a developing baby.

3. In the studies that did find a link to increased birth defects, the actual risk was very small. Among women who took the SSRI Zoloft in the first trimester, only one additional baby in 1,000 was at increased risk for the most common defect, an atrial or ventricular septal defect, also known as a hole in the heart -- that's a very low risk. In fact, 1 in every 33 babies has some type of birth defect regardless of medication use, so it can be very difficult to tell what role a drug may have played, says Christina Chambers, Ph.D., M.P.H., director of clinical research at Rady Children’s Hospital and the Department of Pediatrics at the University of California San Diego.

4. While heart defects sound scary, they aren’t necessarily. Many septal defects are small and resolve on their own during the first year of life, notes Dr. Yonkers. And the small number of children who do need to have a septal defect corrected surgically typically go on to lead a normal, healthy, active life.

5. Premature birth isn’t inevitable. While there is data supporting a greater risk of premature birth for women taking mental health medications, in many cases the pregnancies were only shortened by an average of three to five days.

Of course for most women, posing any risk to the developing baby is not an option, but the need for a mentally healthy mother can be equally important. “I worry a great deal that women are being told that they need to make a choice between their health or that of their baby, and that is not the right message,” emphasizes Dr. Yonkers. “We don’t want to be Pollyana-ish, but there is a whole host of behaviors -- such as smoking -- that are worse for babies.” Many women who suffer from milder depression can do fine with psychotherapy during pregnancy, she notes, whereas other women with more severe illness may be more vulnerable to adverse health behaviors and poor prenatal care if they go off their medication. Bottom line: A mom-to-be should talk to her provider to figure out the option that's right for her. 

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