According to a report in the November issue of the American Journal of Epidemiology a class of medication (Selective Serotonin Reuptake Inhibitors, or “SSRI” commonly used in the treatment of obsessive / compulsive disorder (OCD), anxiety / panic attacks, and major depression may pose a higher risk for birth defects if taken in the first 8 – 12 weeks of pregnancy. In this study a “control group” of 150,780 women who had not used an SSRI, gave birth to 5112 (3.4%) children with congenital malformations, whereas a second group of 1051 women that had filled a prescription for SSRIs at any time during early pregnancy gave birth to 51 (4.9%) children with congenital malformations.
In the latter group, a subset of 452 women that had used an SSRI in the second to third month of pregnancy (the period when the heart, brain, and other vital organs assume their “normal” position as well as function), there were 31 infants (6.8%) born with a congenital anomaly.
The authors of this study readily concede that they found no correlation between SSRI use and specific birth defects. However, the elevated risk of congenital defects among infants whose mothers had used SSRIs in early pregnancy was difficult to “explain away.” In a commentary note published with the study, the lead author pointed out that the group could not measure the impact of environmental factors, socioeconomic status, or the underlying disease process that caused the patient to seek medical attention.
Given the popularity and wide usage of SSRIs (Prozac, etc.), there will undoubtedly be further research on the reported findings.
Believe it or not, there are still quite a few of us that can recall the thalidomide tragedy of the late 1950s and early 1960s. In that scandal thalidomide was marketed as a safe and effective treatment for morning sickness prior to its approval by the Food and Drug Administration (FDA). This was actually legal under the laws that were in place at that time. Fortunately, the application for FDA approval was given to a young woman named Frances Oldham Kelsey.
Kelsey had earned both an MD and PhD degree and was interested in the role of medications that might cause birth defects. Her concerns relative to the drug safety studies led her to reject the application each time it came to her for approval.
In summary (and in regards to brevity), Dr. Kelsey had been correct in her decisions to reject the applications regarding thalidomide’s availability in the . By the time thalidomide was removed from distribution, some 10,000 children had been born with extensive birth defects. Many of these “thalidomide children” had been born with a condition known as phocomelia.
Phocomelia (from the Greek words meaning “seal limbs”) is a defect when the long bones of the arms are either absent or abnormally small. In many cases the hands are attached at the shoulder and there is “webbing” of the fingers. The legs are often fused into a single lower extremity while the feet are also deformed. Children with this defect usually die in childhood.
The purpose of interjecting a description of phocomelia into the report is to demonstrate that, no matter how safe something might appear, the rules during pregnancy are different! When you’re pregnancy you eat for 2, you drink for 2, and whatever else you decide to do is always done for 2!
If you need more proof as to the truthfulness of this observation, check some of my previous postings on the subject. Just remember that many birth defects are preventable.
Wogelius, Pia; Norgaard, Mette; Gislum, Mette; Pedersen, Lars; Munk, Estrid et al: Maternal Use of Selective Serotonin Reuptake Inhibitors and Risk of Congenital Malformations,Epidemiology (2006) 17(6):701-704.
For a brief review of the contributions made by Dr. Kelsey, I would suggest the Wikipedia entries for “Thalidomide” and “Frances Oldham Kelsey.” I definitely recommend the latter entry as an outstanding example of personal and professional integrity.
The information presented in this article and its included links is of an informational nature only and is not intended as a recommendation of any changes in the reader’s health care program. Before making any changes in diet, medications, or other treatments the reader is strongly advised to consult with their health care provider.