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A class of drugs known as selective serotonin reuptake inhibitors—SSRIs—has made a world of difference for thousands of people who live with depression. More commonly known by their brand names Celexa, Prozac, Paxil and Zoloft, these antidepressant drugs are often a key component of treating depression. But for women who are thinking about becoming pregnant, there is reason to pause and think about whether it is safe to continue drug treatment during the pregnancy because many of these SSRIs have been linked to an increased risk of birth defects. Among the possible risks to the fetus are:

Persistent pulmonary hypertension (PPHN): A rare but serious newborn lung condition that results from the failure of the circulatory system to transition to life outside of the womb. While a fetus is in the womb, its oxygen supply comes via the placenta, but at the point of birth, the circulatory system needs to adjust to getting oxygen from the air. When this adjustment doesn’t occur, the newborn will suffer from high blood pressure in the lungs, a condition which may be life threatening.

Septal heart defects, including ventricular and atrial septal defects: septal defects generally refer to “holes in the heart”. In a ventricular septal defect, there are holes in the septal wall that separates the right and left ventricles of the heart. An atrial septal defect refers to holes in the septal wall that separates the upper heart chambers.

Anencephaly: a type of neural tube defect that affect tissues around the spinal cord and brain, specifically resulting in the absence of a large part of the brain and skull. This defect occurs early in fetal development and arises when the upper part of the neural tube fails to close. It can lead to an absence of the skull, absence of the brain (cerebral hemispheres and cerebellum), facial feature abnormalities, and heart defects.

Craniosynostosis: a birth defect in which one more of the joints in the infant’s skull close prematurely and before the infant’s brain is fully developed. As a result, the brain cannot grow and develop in its natural shape and the head is misshapen. At times, the conditions means that the brain itself does not develop normally. If the brain is not affected, then treatment usually involves surgically separating the fused bones to allow the brain the space it needs to grow and develop.

Omphalocele: a birth defect where the infant’s intestine or other abdominal organs, such as the liver or spleen, stick out of the navel, which is an extreme type of hernia. This particular defect arises because the muscles in the abdominal wall do not properly close together.

These birth defects are serious, so although the increased risk of their occurrence may not be extreme, any indication that SSRIs are causing them should not be taken lightly. Any woman who is prescribed SSRI medication and who is thinking about pregnancy should carefully consult with their doctors about possible treatment options and how best to manage these risks.

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