— When Laura Wylie became pregnant for the second time, she
confronted a vexing dilemma: Stay on the antidepressants that
could have adverse effects on her developing baby or risk
descending into a deep, black hole that left her feeling numb.
can’t go through a healthy pregnancy if you’re not in a
healthy state of mind," said Wylie, 35, of west suburban
Oak Park, Ill. "I finally realized that If I had a broken
leg, I wouldn’t be expected to fix it myself. ... The same
thing is true with depression."
years, cautious mothers-to-be and their obstetricians thought
"just say no" was most the prudent approach to any
medication more potent than a cough drop. But abandoning
treatment for chronic health conditions — such as
depression, asthma or diabetes — can sometimes affect the
baby more than taking a medication while pregnant, experts
doctors and patients weigh the risks and benefits of taking
medications during pregnancy and breast-feeding, the Food and
Drug Administration in June will require a new labeling system
for prescription drugs.
we let women with epilepsy just have seizures?" said Dr.
Katherine Wisner, a professor and psychiatrist at Northwestern
University Feinberg School of Medicine, who advised the FDA on
the changes. "Pregnant women get sick and sick women get
pregnant. But somehow we have created this myth of the
revisions to prescription guidelines — the first since 1979
— will provide more up-to-date and specific information to
doctors to help them identify the safest treatment options for
common conditions during pregnancy, said Wisner, who
specializes in maternal mood disorders.
system relied on letter grades of A, B, C, D and X — A for
the most benign medications to X for off-limits. The new
system is designed to give physicians more technical
information when prescribing medications, said Sandy Walsh, an
updated prescribing guidelines consist of three components.
The first gives physicians information on dosing and risks to
the fetus. It also indicates whether data has been collected
to show the drug’s effects — something never required
until now. The second offers what is known about the drug’s
impact on breast-feeding, and the final section addresses how
the product may affect fertility.
letter labels were "confusing and overly
simplistic," Wisner said. "But now doctors and
patients will have quality data to provide better answers. ...
We’re moving from a single letter to more practical
change comes at a time when a growing number of women are
taking medications during their childbearing years. According
to the Centers for Disease Control and Prevention, 90 percent
of all women are on at least one prescription or
over-the-counter drug, while the use of four or more
prescriptions has more than doubled during the past 30 years.
drugmakers have already phased in the changes; the deadline is
June 30. While consumers won’t see new labels on pill
bottles or bags, doctors will have more data to discuss with
more about laying out the information for health care
professionals so they are in a better position to help their
patients make these decisions," Walsh said. "That’s
why the most important thing is for women to still have
conversations with their doctors."
a thicket of often conflicting advice can be daunting. Some
medications are off-limits during the first trimester — when
a fetus’ vital organs are forming — but less problematic
later on. Others are OK early in the pregnancy but not in the
final months. Dosing, too, can be a moving target. Surging
hormones can affect the rate that drugs are metabolized into
when a pregnant woman takes no medication, the overall risk of
birth defects is 3 to 5 percent, according to Suzanne Gilboa,
an epidemiologist with the CDC’s National Center on Birth
Defects and Developmental Disabilities. It’s often difficult
to tease out what is a drug-related defect and what is not.
Pregnant women typically are excluded from double-blind,
placebo-controlled clinical studies, "so a lot of what we
know is from post-marketing surveillance and retrospective
studies, which have more limitations," Gilboa said.
Marsie Hass, who has been a south suburban OB/GYN for more
than 30 years, welcomes more relevant prescribing information,
she said. But the effect of drugs on the developing fetus
should always require case-by-case decision-making, she said.
wants a simple yes or no answer, but often it’s not so
simple," Hass said. "That said, we have to offer
patients something more than ‘medication is bad.’"
case, she said she desperately needed something to regain her
equilibrium in a world turned upside down.
several rounds of fertility treatment, Wylie and her husband,
Sean, received joyous news: They were expecting twins.
July 2013, during the second trimester, a severe cervical
issue made it impossible to carry them to term. After a
premature labor and delivery, the twins lived for an hour but
did not survive.
funeral arrangements was the hardest thing I have ever had to
do," Wylie said.
mired in unbearable pain, which she characterized as "a
deep pit that I could not get out of." She struggled to
get from one breath to the next, unable to string together
more than two hours of sleep a night and crying so much that
her tear ducts ached, recalled Wylie, who acknowledged that
she probably had undiagnosed depression and anxiety for years.
couple shut the door on the nursery, with its two cribs.
body would not let her forget, and her milk came in.
came what mental health experts call intrusive thoughts.
wasn’t thinking about suicide as much as just wanting to be
with the babies. Like if we had a car crash, would it be so
horrible? It meant we could see them," she said.
time later, Wylie found her way to a psychologist who thought
she was grappling with more than grief and referred her to
Wisner, who is also director of Northwestern’s Asher Center
for the Study and Treatment of Depressive Disorders.
prescribed two antidepressants, Zoloft and Trazodone. Within
days, Wylie said she noticed a difference — if for no other
reason than she was getting more sleep.
small victories followed — making it through a TV show,
walking to the end of the block, then getting all the way
around the block. Sean still had to make sure the path was
stroller-free, but she did it.
couple took another step forward when they continued to try to
conceive. "I didn’t know if I could get this miracle
again ... but I knew I couldn’t get there unless I could
level off in some way."
untreated psychiatric illnesses can have negative effects on
babies in utero, producing higher levels of stress hormones
that can reduce fetal growth and increase the risk of
premature labor, Wisner said.
already risky postpartum period, with an incidence of
depression as high as 20 percent, can be even more dangerous
if the illness goes untreated during pregnancy, she said,
leaving the new mother unable to properly care for or bond
with the newborn.
Wylie became pregnant again, she wrestled with her options.
She weighed the risks of a pregnancy with and without
antidepressants. In the end, she decided to remain on her
talking to Dr. Wisner and thinking it over, where I landed was
that one scenario — not taking medication — was very
likely to be a bad experience for me and the baby, whereas
taking the medication would enable me to stay more emotionally
capable and carried a small chance of something
happening," she said.
I sadly know, there are no certainties when it comes to
pregnancy and childbirth. I think every woman needs to make
decisions that take both her and the baby’s health into
25, 2014, Matilda was born. Today she is a healthy
meds were comforting. I trusted my doctor ... and it
worked," Wylie said. "And now I have this amazing,
healthy, beautiful baby girl."