Are antidepressants as a drug class linked to birth defects?
July 22, 2015
A new study sheds some light on the risk profile of antidepressants. Plus: do women experience the same blood pressure elevation following alcohol consumption as men? And, do feminine products provide another source of exposure to phthalates?
A multicenter study of women who used selective reuptake inhibitors (SSRIs) around the time they conceived shows an association with birth defects-but that the risks are not the same for all drugs in that class. Published in BMJ, the findings offer reassurance about some SSRIs while pointing to a need for caution in use of paroxetine or fluoxetine early in pregnancy.
Nearly 18,000 mothers of infants with and nearly 10,000 mothers of infants without birth defects were included in the Bayesian analysis, which was designed to look at associations between 14 categories of birth defects and SSRIs that had previously been reported in the literature. The data were from the US National Birth Defects Prevention Study, a case-control study of birth defects. The deliveries occurred in 10 different states and spanned 1997 to 2009 and the women were asked specifically about their use of SSRIs from 3 months before conception to the birth of their babies.
Among the women who bore infants with birth defects, 659 had been exposed to citalopram, escitalopram, fluoxetine, paroxetine, or sertraline during pregnancy, versus 298 in the control group. Sertraline was the most commonly used SSRI; about 40% of women in the control group reported using it.
The researchers’ findings showed no support for previous reports of an association between maternal SSRI use and 9 selected birth defects. None of the five previously reported associations between sertraline and birth defects were confirmed. However, high odds ratios were found for five birth defects with paroxetine (anencephaly 3.2, 95% credible interval 1.63-6.2; atrial septal defects 1.8, 1.1-3.0; right ventricular outflow tract obstruction defects 2.3, 1.4-3.9; gastroschisis 2.5, 1.2-4.8; and omphalocele 3.5, 1.3-8.0) and for two defects with fluoxetine (right ventricular outflow tract obstruction defects 2.0, 1.4-3.1 and craniosynostosis 1.9, 1.1-3.0).
The analysis, the authors said, “confirms the need to assess the association between specific SSRIs and specific birth defects rather than combining an entire drug class or heterogeneous group of birth defects.” While the data on use of SSRIs were self-reported by the mothers, the researchers consider it a strength of the study that the information reflected use of medications and not just prescriptions that were filled. They believe that their analysis offers a major advantage over previous reports in that individual SSRIs and birth defects were assessed, while accounting for earlier reported associations.
A new Australian study seems to show that after consuming alcohol, women may experience blood pressure elevation similar to that reported in studies of men.
The small study involved 24 women aged 25 to 49 years who had a mean alcohol intake of 202±94 g alcohol/wk and a mean 24-hour systolic and diastolic blood pressure of 10.2±8.9/68.9±5.7 mm Hg. The participants were randomized for a 3-period cross-over study. Every evening for 4 weeks, participants were required to drink a higher-volume red wine (lower-level drinkers, 146 g alcohol/wk; higher-level drinkers, 218 g alcohol/wk), lower-volume red wine (lower-level drinkers, 42 g alcohol/wk; higher-level drinkers, 73 g alcohol/wk), or dealcoholized red wine. The consumption requirements were then rotated until each individual had consumed all 3 types of alcohol.
When compared to the dealcoholized red wine, the higher-volume red wine was shown to significantly increase 24-hour systolic and diastolic blood pressure (1.2±0.4/2.0±0.6 mm Hg; P=0.028 and P=0.001, respectively). A similar effect was also seen for higher-volume and lower-volume red wine (1.6±0.6/1.4±0.4 mm Hg; P=0.014 and P=0.005, respectively).
Alcohol appeared to have the most impact on blood pressure while participants were awake rather than while they were asleep. No significant differences in blood pressure were reported between the dealcoholized red wine and the lower-volume red wine.
The researchers concluded that regular consumption of 146 to 218 g alcohol/wk elevates 24-hour systolic and diastolic blood pressure. Further, the increases seen were similar to results from intervention studies in which men participated.
Vaginal douching and other feminine care products may be another possible source of exposure to phthalates, which have been associated with adverse effects on reproductive, endocrine, and developmental systems, according to a new study. Black women appear to be more likely to report use of vaginal douching than their white and Mexican American counterparts.
Researchers conducted a cross-conditional study on 739 women aged 20 to 49 who were part of the National Health and Nutrition Examination Survey from 2001 to 2004. They examined the association of self-reported use of feminine hygiene products such as vaginal douches, feminine spray, and tampons with urinary concentrates of monoethyl phthalate (MEP) and mono-n-butyl phthalate (MnBP), which are metabolites of diethyl phthalate and di-n-butyl phthalate.
Overall 37% of black women reported douching in the previous month, compared with 14% of white and 10% of Mexican-American women. In addition, 20% of black women indicated that they douched frequently, compared with 7% of white women and 3% of Mexican-American women. As such black women had significantly higher geometric mean concentrations (ng/mL) of MEP and MnBP in comparison to their white or Mexican-American counterparts.
In both adjusted and unadjusted models, douching was associated with increased urinary MEP concentrations. Women who reported douching in the previous month had 51.6% (95 % CI: 18.8 % to 93.6 %) higher concentrations of MEP than non-users in the adjusted model. Women who reported occasionally using a douche in the past 6 months had 33.6% (95% CI: -0.3% to 79.2%) higher concentration of MEP than non-users and women who reported frequent douching had 152.2% (95% CI: 68.2% to 278.3%) higher MEP concentrations than those who did not use douches. An association was seen between douching and MnBP concentration, but it wasn’t statistically significant. No significant associations were noted between other forms of feminine hygiene products and either MnBP or MEP concentrations.
Investigators concluded that vaginal douching appears to be a source of human exposure to diethyl phthalate and contributes to the racial and ethnic disparities seen in diethyl phthalate exposure. They urge further research to confirm the findings and to assess other endocrine-disrupting chemicals that may be contained in vaginal douches.