INDUSTRY & RESEARCH campusreview. com. au
Understanding the risks
A University of Melbourne professor puts into perspective a study linking antidepressants to birth defects.
Anne Buist interviewed by Loren Smith
Fluoxetine, the antidepressant in drugs such as Prozac and Lovan, has been found to increase the risk of birth defects when taken during pregnancy.
A meta-analysis of 16 studies, published in the British Journal of Clinical Pharmacology, determined that fetuses exposed to fluoxetine during the first trimester were 18 per cent more likely to develop a major defect, and 36 per cent more likely to develop a cardiovascular defect.
Anne Buist, a professor of women’ s mental health at the University of Melbourne, who was not involved in the meta-analysis, says the results aren’ t as alarming as they might seem.
For one, doctors caution against being on any medication while pregnant, she says, and in determining drug use, they weigh up the interests of the mother-to-be against those of the unborn child.
“ For women with serious illnesses, there is no riskfree option in pregnancy. Of note, there is no risk-free option for any woman,” Buist says in a statement.
However, the mother isn’ t the only person affected by ceasing needed medication. Fetuses exposed to a mother’ s anxiety have higher cortisol( stress hormone) levels at birth, which places them at an increased risk of future mental health issues.
Buist adds that fluoxetine is not the first choice of antidepressant for pregnant women, or for those trying to conceive, specifically because of its link to birth defects.“ I doubt fluoxetine is the most popularly prescribed antidepressant in the childbearing age group,” she says.
In addition, fluoxetine’ s risks can be mitigated by lowering the dosage, Buist says.
Lastly, she notes that other factors associated with female antidepressant use, such as corpulence, diabetes, smoking, and illicit drug and alcohol use, weren’ t all controlled for in the various studies.
Buist sits down with Campus Review to discuss the meaning and implications of this study.
CR: Could I just get your general thoughts on the meta-analysis?
AB: Meta-analyses are now very common in this sort of research because there are problems with all sorts of studies in this area. Getting the numbers and being able to calculate risk ratios and then pool this data together really helps us get a better perspective of things.
One of the biggest problems is any research in pregnancy can ' t have a randomised control trial. We ' re always relying on data that is biased in some way or another. The biggest issue for the studies is that women on antidepressants are not the same as women not on antidepressants in a whole number of factors, and some of those factors may also influence pregnancy outcome.
If you look at them all, [ one group that has ] come up with differences in particular are women with
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