June 25, 2015

SSRI Use In Pregnancy

depression miscarriage antidepressants

Many women with infertility suffer depression and are treated with a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). The most commonly prescribed antidepressant of this class is Sertraline whose brand name is Zoloft. Increasing evidence suggests that the use of SSRIs during the first trimester of pregnancy is associated with major congenital malformations. SSRI use in pregnancy may also lead to pulmonary hypertension in newborns.

A recent register-based cohort study using data from the Quebec Pregnancy Cohort which is an on-going population-based cohort with prospective data collection on all pregnancies that occurred from January 1989 through December 2010 in the province of Quebec reported (Am J Obstet Gynecol 2015;212:795) that Sertraline use during pregnancy was associated with an increased risk of atrioventricular defects and craniossynostosis (Kray-nae-o-sin-os-TOE-sis). Atrioventricular defects is a congenital anomaly of the heart where the internal heart wall separating the atrium from the ventricle does not properly form. Craniossynostosis is another serious birth defect where one or more bones of the skull close prematurely before your baby’s brain is fully formed. This causes the brain not to grow properly and the head to be misshapen.

Depression is common in women suffering infertility and in pregnancy. Treatment options should focus on non-pharmacologic means since commonly prescribed medications may cause irreparable harm to a long sought after pregnancy.

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Joseph A. Hill, III, M.D.

Joseph A. Hill, III, M.D. Board-Certified in Reproductive Endocrinology and Infertility