WEDNESDAY, Nov. 29 (HealthDay News) -- A group representing America's obstetricians is recommending that women avoid the antidepressant Paxil if they are pregnant or planning on becoming pregnant, due to a potential heightened risk for birth defects.
The American College of Obstetricians and Gynecologists (ACOG) also cautioned that treatment with other antidepressants should be considered on a case-by-case basis.
ACOG's Committee on Obstetric Practice "recommends that treatment with all SSRIs [selective serotonin reuptake inhibitors] or selective norepinephrine reuptake inhibitors or both during pregnancy be individualized and paroxetine [Paxil] use among pregnant women or women planning to become pregnant be avoided, if possible," read the statement, which is in the December issue of Obstetrics & Gynecology.
The guidelines come a full year after the U.S. Food and Drug Administration (FDA) issued a warning about possible birth defects associated with Paxil when the drug is taken during the first trimester of pregnancy.
This warning was based on two studies. The first found about a 2 percent risk of heart defects in babies born to mothers who took Paxil early in their pregnancy, compared with a 1 percent risk in the general population.
The second study found that the risk of heart defects was 1.5 percent in babies whose mothers took Paxil in the first three months of pregnancy, compared with 1 percent in babies whose mothers took other antidepressants in the first trimester. The most common defects were cardiovascular.
"Since the FDA warnings a year ago, most ob/gyns have been trying to avoid Paxil during pregnancy," noted Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City. "This is just a formal statement by ACOG."
The initial FDA warning came in September of 2005. In December of the same year, the FDA instructed Paxil's maker, GlaxoSmithKline, to reclassify the drug from a Category C to D (a stronger warning) for pregnant women. Category D means studies in pregnant women have demonstrated a risk to the fetus.
Other reports had indicated that SSRIs, the category of antidepressants which includes Paxil as well as Celexa, Prozac and Zoloft, may cause newborns to have withdrawal symptoms.
ACOG acknowledged that these potential problems must be weighed against yet another study which found that pregnant women who discontinue their antidepressant medication are five times more likely to relapse into depression than women who continue with the medication.
"Untreated depression has its own risks, including low weight gain, alcohol and substance abuse, and sexually transmitted diseases, all of which have negative maternal and fetal health implications," the statement said.
Women of reproductive age have the highest prevalence of major depressive disorders, with ACOG experts estimating that about 1 in 10 will experience a bout of major or minor depression sometime during pregnancy or the postpartum period.
Ideally, these issues should be considered before a woman becomes pregnant, the ACOG panel said. But, given that about half of all pregnancies are not planned, many decisions regarding treatment will inevitably happen after the woman has conceived. Fetal echocardiography, which looks for heart trouble, should be considered for women who were exposed to Paxil in early pregnancy, the statement recommended.
"Women who have certain health problem such as depression really should try to plan their pregnancies with their ob/gyn and psychiatrist," Wu confirmed. "The major danger will be to women who have an unplanned pregnancy and don't realize it until they're two months along. There's a lot of organ development during that time, and exposure to certain SSRIs may pose some dangers." ↓
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| Name: Julia | Date: Nov 30th, 2006 9:47 PM |
| This is great information to know. Thanks! ↑ |
| Name: Hiddy | Date: Nov 30th, 2006 10:19 PM |
Sometimes the severity of the depression far outweighs the risk of the drug. I havent taken anti depressants during pregnancy but I know women who have, and who have really needed to. Its okay to cut and paste this information, but doctors know the risks and they also know how to assess if someone really has a need to be on a medication such as zoloft. You shouldnt be scaring people like this, as some women really need the aid of medication and might not seek out help with something like this being posted.
There are MANY medications that women can take during pregnancy for different things, each comes with some sort of risk ↑ |
| Name: Hiddy | Date: Nov 30th, 2006 10:21 PM |
| and 2%???? 1.5%????? Im sure you would have those sort of figures anyway...paxil or not ↑ |
| Name: Hiddy | Date: Nov 30th, 2006 10:55 PM |
Stacy,
Do you actually ever talk to anyone? Or do you just come in and cut and paste articles that favour your opinions? ↑ |
| Name: Stacy | Date: Dec 1st, 2006 3:00 PM |
Hiddy,
It you remember we had avery nice conversation on the therapy & drug post. It you remembered, I agreed with you :)
This is information only. As the article states "Ideally, these issues should be considered before a woman becomes pregnant, the ACOG panel said. But, given that about half of all pregnancies are not planned, many decisions regarding treatment will inevitably happen after the woman has conceived. Fetal echocardiography, which looks for heart trouble, should be considered for women who were exposed to Paxil in early pregnancy, the statement recommended." The article also states "ACOG acknowledged that these potential problems must be weighed against yet another study which found that pregnant women who discontinue their antidepressant medication are FIVE TIMES more likely to relapse into depression than women who continue with the medication" '"Untreated depression has its own risks, including low weight gain, alcohol and substance abuse, and sexually transmitted diseases, all of which have negative maternal and fetal health implications,"
Personally I don't feel that if the general population is at a 1% risk for heart defects & a mother on Paxil risk is 2%, that it is a significant enough increase in risk to stop taking the medication in someone who is severely depressed.
On the other hand if you have mild depression and are planning on getting pregnant, why not stop taking the medicine prior to becoming pregnant & thru the first trimester. Then once your in your second trimester you can safely resume taking your medication. ↑ |
| Name: Stacy | Date: Dec 1st, 2006 3:05 PM |
Only you and your Dr can determine what is best for your individual case.
If you became unexpectedly pregnant while taking Paxil, would you want your Dr, to know the risks. That way they can keep a closer watch on your babys heart.
Ideally, these issues should be considered before a woman becomes pregnant, the ACOG panel said. But, given that about half of all pregnancies are not planned, many decisions regarding treatment will inevitably happen after the woman has conceived. Fetal echocardiography, which looks for heart trouble, should be considered for women who were exposed to Paxil in early pregnancy, the statement recommended ↑ |
| Name: atomic snowflake | Date: Dec 1st, 2006 3:52 PM |
| I was taking Paxil in early pregnancy and my baby died at 12 weeks gestation. I didn't find out until 14 weeks though. ↑ |
| Name: Stacy | Date: Dec 1st, 2006 4:14 PM |
| I'm so sorry for your loss Atomic. ↑ |
| Name: atomic snowflake | Date: Dec 1st, 2006 4:23 PM |
| Thanx - I've got two boys now and I'm okay, but I often wonder if the Paxil caused the baby to die. I was trying to come off it when I found out that I was pregnant. ↑ |
| Name: Stacy | Date: Dec 1st, 2006 9:35 PM |
Atomic,
As you well know 1 out of 5 pregnancys end in miscarriage. Did the Dr not sent the fetus for an autopsy? I just ask because the pathology report would have given you some idea as of why the fetal demise. ↑ |
| Name: atomic snowflake | Date: Dec 1st, 2006 10:16 PM |
| No, they don't do that in the UK. I think that you have to lose three babies before they'll do investigations. As far as I know they just removed the baby and sent it out with the medical waste. I don't even know what sex it was. I was too upset to ask any questions at the time. ↑ |
| Name: Stacy | Date: Dec 2nd, 2006 2:27 AM |
| Name: Stacy | Date: Dec 11th, 2006 3:32 PM |
| Name: Stacy | Date: Jan 6th, 2007 11:37 PM |
This was brought up else where so I thought I would move it to the top again.
Sorry if you've already read this. ↑ |
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