Paxil During Pregnancy and Birth Defects

by on July 30, 2012

New studies suggest that antidepressant medications belonging to the group of drugs known as selective serotonin reuptake inhibitors (SSRIs), including Paxil (paroxetine), may increase the risk of birth defects during pregnancy. In response, the Food and Drug Administration has changed their classification of Paxil from Pregnancy Category C to D, which means that it has been shown to cause harm on the unborn child.

Paxil should generally be avoided during pregnancy.  However, drugs classified under Pregnancy Category D may still be given to pregnant women if the perceived benefits outweigh the possible risks and in special situations, such as in cases of severe depression that does not respond to other treatment options.

According to the American College of Obstetricians and Gynecologists (ACOG), the decision about use of SSRIs during pregnancy should be made on an individual basis. However, it stressed that pregnant women or those planning to become pregnant should specifically avoid using paroxetine.

If you are taking this medication, you need to discontinue use or switch to other treatment alternatives before conceiving. Take note, however, that you must not abruptly stop taking the drug as it can lead to certain withdrawal symptoms.

What Studies Say

Previous studies on Paxil did not show significant difference in the chances of miscarriages and birth defects in pregnant women who used this medication and those who did not. However, newer findings reveal that paroxetine, as well as other SSRIs, may increase these risks in pregnant women.

Studies show that fetal exposure to Paxil during the first three months of pregnancy increases the risk of birth defects, particularly heart defects. Compared to women who did not take Paxil, women who took Paxil during the first three months of pregnancy have about one-and-a-half to two times chances of giving birth to a baby with a heart defect.

The most commonly reported heart defects include atrial and ventricular septal defects.

Recent findings also suggest that babies born to mothers who took SSRIs like Paxil during pregnancy have more chances of being born prematurely, longer hospital stays, low birth weight, and difficulty thriving in external environment. This is especially common among infants born to mothers who are taking Paxil for mental conditions, or those who are smoking or drinking alcohol.

Furthermore, withdrawal symptoms have been noted in infants born to mothers who took SSRIs during the latter stage of pregnancy. Infants may develop symptoms that include irritability, increased crying, tremors, and convulsions. These symptoms often wane off within one to four days after birth. Some healthcare providers recommend gradually tapering off the dose at least two weeks before expected delivery date to avoid possible drug withdrawal symptoms.

Other Recommendations

The FDA recommends that healthcare providers discuss with their patients the potential risks and benefits of using this medication during pregnancy. To avoid any risk on the infant, Paxil should be used only if all other treatment alternatives fail or are not appropriate. Take note that in some patients, taking this medication may be more beneficial.

Finally, clinical depression and other emotional conditions during pregnancy can negatively impact the development of the child. It is important to consult your healthcare provider, psychiatrist or counselor for the best treatment option. These healthcare professionals can help you figure out the best way to manage and treat your condition.