(RxWiki News) Women who have anxiety or depression have important decisions to make about their medications when they are pregnant. Though these medications may carry some risks, not taking them has risks too.
A recent study found a slightly increased risk for heavy bleeding after giving birth in women who had taken antidepressants within 24 hours before giving birth.
The increased risk was low, and it was even lower when women had not taken the antidepressants within one to 30 days before giving birth.
Women should discuss with their OB/GYN and mental health doctor the best options for medication during pregnancy and around the time of giving birth.
"Ask your OB/GYN about taking antidepressants near your due date."
This study, led by Kristin Palmsten, a postdoctoral research fellow in epidemiology at Harvard School of Public Health, looked at the risk of hemorrhaging after giving birth in women who took antidepressants.
Hemorrhaging means severe bleeding.
The researchers used data from 106,000 low-income pregnant women enrolled in Medicaid from 2000 through 2007.
The women were all aged 12 to 55 and had been diagnosed with a mood or anxiety disorder. They were divided into four groups based on whether and when they took antidepressants:
- Those who were taking antidepressants at the time that they gave birth
- Women who had taken antidepressants within one to 30 days before giving birth
- Women who had taken antidepressants between one and five months before giving birth
- Women who had not taken antidepressants within five months before giving birth
The antidepressants included two types: serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil), citalopram (Celexa), sertraline (Zoloft) and escitalopram (Lexapro), as well as non-serotonin reuptake inhibitors such as bupropion (Wellbutrin).
A total of 12,710 women, or 12 percent of the total, were taking SSRIs when they gave birth, and 1,495 women, or 1.4 percent of the total, were taking non-serotonin reuptake inhibitors when they gave birth.
The researchers adjusted their analysis to account for other factors that might influence a woman's risk for hemorrhaging after giving birth.
These factors included age, race, the year she gave birth, having diabetes, having multiple babies, having a clotting or bleeding disorder, the severity of the woman's mood/anxiety disorder, other mental health conditions, use of other medications and health based on recent hospital visits.
The researchers found the following rates of hemorrhaging in each group of women:
- 2.8 percent in women who had not taken any antidepressants within five months before giving birth
- 4 percent in women who were taking SSRIs at the time that they gave birth
- 3.8 percent in women who were taking non-serotonin reuptake inhibitors at the time that they gave birth
- 3.2 percent in women who had taken SSRIs within one to 30 days before giving birth
- 3.1 percent in women who had taken non-serotonin reuptake inhibitors within one to 30 days before giving birth
- 2.5 percent in women who had used SSRIs within one to five months before giving birth
- 3.4 percent in women who had taken non-serotonin reuptake inhibitors within one to five months before giving birth
Therefore, among women who were taking SSRIs at the time they gave birth, an additional 1.2 percent of them experienced hemorrhaging than those not taking SSRIs at delivery.
Put another way, for every 80 women taking SSRIs when they gave birth, one would experience hemorrhaging.
Among women taking non-serotonin reuptake inhibitors at the time of giving birth, an additional 1 percent of them experienced hemorrhaging.
For every 97 women taking these antidepressants at the time of delivery, one would experience hemorrhaging.
The increased risk was small, and it was even lower when the women had not taken the antidepressant more than a day before delivery.
According to Andre Hall, MD, an OBGYN at Birth and Women's Care, PA in Fayetteville, NC, women's decisions regarding antidepressant use come down to a risk-benefit analysis.
"The use of medications in pregnancy, including the use of antidepressants, must pass the test that the benefits of the use of the drug must outweigh the risk to the mother and unborn child," Dr. Hall said.
"During my career I have seen a change in the pregnancy classification of SSRI antidepressant medications from a more favorable classification to a less favorable classification," he said. "Even with this less favorable classification, there are instances in which the benefits of the antidepressants in achieving mental stability and overall improved mental health outweigh the potential risks of the medication."
Dr. Hall said this study specifically looks for whether there is an increased risk of bleeding in women taking this medications close to delivery.
"I believe if there is an increased risk, the risk is small and not clinically significant," he said. "Further, I believe the importance of mental stability at a time of great personal life changing transition is far more important than the risk of bleeding at delivery."
"Because of this, once the decision has been made that the benefits of the medications outweigh the risk, I would not suggest discontinuing their use around delivery due to a concern of increased bleeding at delivery," Dr. Hall said.
This study was published August 21 in the journal BMJ. The research was funded by the Agency for Healthcare Research and Quality and the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health.
The Harvard School of Public Health receives support from Pfizer and Asisa. One author has done consulting for GlaxoSmithKline and Novartis and another had received research funding from Pfizer, Otsuka, Janssen, Pine Rest Foundation, Novartis, AssureRx and Priority Health.