What are the risks of taking Effexor (Venlafaxine) during the first trimester of pregnancy?

From the Guidelines

Taking Effexor during the first trimester of pregnancy does not substantially increase the risk for neurodevelopmental problems such as ASD and ADHD, according to the most recent research 1. When considering the use of Effexor during pregnancy, it's essential to weigh the potential risks and benefits. The research suggests that intrauterine antidepressant exposure, including Effexor, does not substantially increase the risk for neurodevelopmental problems such as ASD and ADHD 1. However, other risk factors, including having a mother with an indication for antidepressant treatment, may contribute to the increased occurrence of these conditions.

Some key points to consider:

• The American Psychiatric Association and the American College of Obstetricians and Gynecologists recommend that women and their doctors work together to consider the severity of current symptoms, previous mental health history, and patient treatment preferences when making decisions about antidepressant use during pregnancy 1.
• A stepped approach to treatment of depression during pregnancy is recommended, with women with mild depression being monitored and encouraged to exercise and seek social support, while those with moderate-to-severe depression should seek evidence-based treatment 1.
• Evidence-based psychotherapies, such as cognitive therapy, and antidepressants are roughly equally effective at treating depression 1.
• The decision to continue or discontinue Effexor during pregnancy should balance the mother's mental health needs against potential fetal risks, and the lowest effective dose should be used if medication is needed during pregnancy.

It's crucial to note that abruptly stopping Effexor can cause withdrawal symptoms and potentially worsen depression, which itself poses risks during pregnancy. Therefore, it is recommended that women with severe depression or anxiety work closely with their healthcare provider to determine the best course of treatment during pregnancy, considering the potential benefits and risks of Effexor use 1.

From the FDA Drug Label

Venlafaxine did not cause malformations in offspring of rats or rabbits given doses up to 11 times (rat) or 12 times (rabbit) the maximum recommended human daily dose on a mg/kg basis, or 2. 5 times (rat) and 4 times (rabbit) the human daily dose on a mg/m2 basis. However, in rats, there was a decrease in pup weight, an increase in stillborn pups, and an increase in pup deaths during the first 5 days of lactation, when dosing began during pregnancy and continued until weaning. There are no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed Non-teratogenic Effects Neonates exposed to venlafaxine HCl, other SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), or SSRIs (Selective Serotonin Reuptake Inhibitors), late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding.

The risks of taking Effexor (venlafaxine) during the first trimester of pregnancy include:

• Potential harm to the fetus: Although venlafaxine did not cause malformations in animal studies, there is a lack of adequate and well-controlled studies in pregnant women.
• Increased risk of stillborn pups and pup deaths: Animal studies have shown an increase in stillborn pups and pup deaths when dosing began during pregnancy and continued until weaning.
• Decrease in pup weight: Animal studies have also shown a decrease in pup weight. It is recommended that venlafaxine should be used during pregnancy only if clearly needed, as the potential risks and benefits of treatment should be carefully considered 2.

From the Research

Risks of Taking Effexor During Pregnancy First Trimester

• The study 3 found no statistically significant differences in the hazard of spontaneous abortion following gestational venlafaxine use compared with either antidepressant unexposed or SSRI exposed pregnancies.
• Another study 4 compared the effects of prenatal exposure to venlafaxine, selective serotonin reuptake inhibitors (SSRIs), and maternal depression on child neurodevelopment, and found that the children exposed to venlafaxine, SSRIs, and maternal depression during pregnancy had similar full-scale IQs.
• A study on rats 5 found that perinatal exposure to venlafaxine led to lower anxiety and depression-like behavior in the adult rat offspring, suggesting that prenatal and early postnatal exposure to venlafaxine may interfere with functional development of the brain.
• However, a study 6 found that venlafaxine was associated with multiple birth defects, including anencephaly and craniorachischisis, which persisted after partially accounting for underlying conditions.

Birth Defects and Effexor

• The study 6 found elevated associations between venlafaxine and multiple birth defects, including:
  • Anencephaly and craniorachischisis: aOR, 9.14; 95% CI, 1.91-43.83
• These findings suggest that venlafaxine may be associated with an increased risk of certain birth defects, although the results need to be confirmed given the limited literature on venlafaxine use during pregnancy and risk for birth defects.

Depression and Effexor

• A study 7 found that an exercise programme during pregnancy may reduce the prevalence of depression in late pregnancy and postpartum, highlighting the importance of managing depression during pregnancy.
• The study 4 found that depression during pregnancy is a significant risk factor for postpartum depression, and that children of depressed mothers may be at risk of future psychopathology.