WATERLOO - Moms-to-be memorize a litany of nutritional dos and don'ts.
Foods rich in calcium and folic acid are in. Alcohol and tobacco are out, with some expectant mothers even avoiding over-the-counter medications.
But for pregnant women with anxiety or depression, prenatal rules aren't cut-and-dried. Antidepressants can cause birth defects, but a mother's untreated mental illness also may harm the unborn child. Guidelines released this fall by the American Psychiatric Association and the American College of Obstetricians and Gynecologists aim to help physicians and their patients choose the most appropriate treatment option.
"It's a balancing act of what is the risk to the woman from the disease versus what is the risk from those medications," said Dr. Susan Wing of Waterloo's Partners in Obstetrics and Gynecology.
Paxil, specifically, and other SSRIs (selective serotonin reuptake inhibitors), are associated with a potentially increased risk of heart defects, the majority of which are asymptomatic and resolve spontaneously, Wing said. Other studies have linked antidepressant use to fetal malformations, pulmonary hypertension and low birth weight. In some cases, the babies go through withdrawal after delivery. But stopping medication isn't necessarily a better option. Women with depression have an increased risk of experiencing pre-term labor, pre-eclampsia and other complications. They also may harm themselves.
"The question is: Is that because they have untreated mental health disease, or is it that they are more likely to not take care of themselves or drink or have other unhealthy behaviors if they have untreated mental health disease," Wing said. "There's not really a study out there that can answer that."
To determine the best option, Wing sometimes refers patients to mental health counselors. One in five women will have a problem with depression in her lifetime, in many cases occurring during or following pregnancy, she said.
"It's important to get good health care information for anything, but certainly for this," said Karl Moe, a psychologist with Cedar Falls Counseling Associates. "There's a different answer for every woman."
Some patients may need medication and counseling, he said. Others may be able to treat their condition with behavioral or talk therapy alone. For women with a history of anxiety or depression, a consultation with both a medical doctor and a therapist is advised, Moe added.
"There are a lot of things they need to think about," he said. "There are two lives that are part of the consideration."
In 2003, Julie Edgington was among the roughly 13 percent of expectant U.S. women to take an antidepressant during pregnancy. The Waterloo woman started a Paxil regimen a few weeks before she became pregnant with her son, Manie.
"I really didn't feel right about taking it because with all my other children I never took anything - I was even careful with Tylenol," said the mother of five. "I was completely off it by the end of the third month of my pregnancy, but by that time it was too late."
Manie was born with his aorta and pulmonary arteries switched. At just 8 days old he underwent open-heart surgery. Manie will have to repeat the procedure when he is 17 and requires continued care. Edgington and her husband, Russell McNamee, along with several other families across the country, have a lawsuit pending against GlaxoSmithKline, which manufactures Paxil.
Today, Edgington blogs about her experiences. Although Manie's case is rare, she warns other moms that - in her opinion - antidepressant use during pregnancy is too big of a risk.
"What benefits could be great enough to put your child through a lifelong battle with their health?" she asked. "I'm not a doctor, but I would definitely tell someone to try some other type of therapy before taking anything. It's not worth it."