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Heart Defects

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When women take antidepressants while pregnant, there is a risk their babies may be born with serious heart defects.

Every year in the United States, more than 80,000 pregnant women are prescribed selective serotonin reuptake inhibitors (SSRIs) for depression, with Prozac (fluoxetine) being the most popular choice.

Yet multiple studies during the last decade have found that when a pregnant woman takes an antidepressant, it puts her baby at an increased risk for heart defects and other birth defects. The overall risk for birth defects caused by an antidepressant is low.

But, in 2009, GlaxoSmithKline was ordered to pay $2.5 million to the family of a baby who was born with heart defects caused by his mother’s use of Paxil – an antidepressant -- during pregnancy. It was the first of hundreds of lawsuits against Glaxo over Paxil-induced birth defects.

The heart complications prompted Eli Lilly, which manufacturers Prozac, to admit in 2011 that "there is some evidence of a possible small increase in the risk of cardiac malformations (eg ventricular and septal defects) associated with use of fluoxetine."

Following this admission, women have sued Eli Lilly, GlaxoSmithKline and other drug manufacturers after giving birth to a baby with birth defects or who later developed complications from antidepressant use during pregnancy.

Heart Defects Linked to Antidepressants

In 2005, Danish researchers found that if a mother takes an antidepressant during the first trimester, her child has a 60 percent greater chance of developing a heart problem than the general population.

A study published in the British Medical Journal in 2009 found that the use of more than one type of antidepressant during the first trimester translated to a fourfold increase in babies born with septal heart defects — or holes in the walls of the heart. The study also found that the greatest risks were associated with use of Zoloft (sertraline) and Celexa (citalopram).

A study published in the July 2011 issue of Obstetrics and Gynecology found that women who take antidepressants during the first trimester are twice as likely to have babies with isolated ventricular septal defects and four times more likely to deliver babies with right ventricular outflow tract defects.

Types of Heart Defects

The heart is divided into four parts — the left and right atrium and the left and right ventricle. The most common types of birth defects linked to the mother's use of an antidepressant are atrial septal defects (ASD) and ventricular septal defects (VSD).

With ASD, the different pressures in the chambers of the heart are affected. Extra blood in a chamber from a hole in the wall can mean the heart has to work harder to pump the blood where it needs to go. This, in turn, can lead to an enlarged organ and, ultimately, heart failure.

VSD means a portion of the heart wall did not form correctly. A heart murmur can be detected because of an abnormal flow of blood in the heart, but may be difficult to identify in infants.

Other heart defects in babies that have been linked to antidepressant use during pregnancy include:
Tetralogy of fallot Hypoplastic left heart syndrome
Transposition of the great arteries (TGA or TOGA) Patent ductus arteriosus (PDA)
Total anomalous pulmonary venous return (TAPVR) Double outlet right ventricle (DORV)
Coarctation of the aorta (CoA).

Persistent pulmonary hypertension of the newborn (PPHN), also has been linked to antidepressant use during pregnancy, and also damages a newborn's heart.