Nervous system drugs linked to leukemia - maternal exposure, fetal effects - folic acid protective - eg, Seconal, Valium, Halcion, Ambien

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Nervous system drugs linked to leukemia

By ANDRÉ PICARD

From Wednesday's Globe and Mail

http://www.theglobeandmail.com/servlet/story/RTGAM.20041229.wxleukemia29/BNStory\

/specialScienceandHealth/

Women who take some forms of antidepressants or anti-anxiety drugs

during pregnancy greatly increase the risk that their children will

develop leukemia, according to a new Canadian study.At the same time,

the research suggests that the risk of the most common form of childhood

cancer can be virtually eliminated by taking folic acid supplements

during pregnancy.

The findings show that taking central nervous system depressants -- a

category that consists of a wide range of drugs including barbiturates

like Seconal, anti-anxiety drugs like Valium, and sleeping pills like

Halcion and Ambien -- while pregnant leads to a six-fold increase in a

child's risk of developing acute lymphoblastic leukemia. Those drugs are

all used to help treat depression.

" If you can avoid these drugs during pregnancy, you should, " said

Infante-Rivard, a professor of epidemiology at McGill University in

Montreal and one of the study's authors.

But she cautioned that the dangers of women stopping psychiatric

treatment abruptly are significant and any decision about medications

should be made in conjunction with a physician.

" This data is concerning, but we have to be measured in our response, "

Dr. Infante-Rivard said.

The study, published in the medical journal Cancer Causes and Control,

found that an alarmingly high number of women -- one in seven -- take

drugs during pregnancy that can harm the fetus.

These so-called teratogenic drugs include CNS antidepressants, epileptic

drugs, immunosuppressants, oral contraceptives, anti-nausea drugs and a

number of illicit drugs.

The data show that antidepressants, by far, pose the greatest risk. That

is likely because the childhood cancer acute lymphoblastic leukemia

tends to originate in the central nervous system.

The study did not look specifically at selective serotonin reuptake

inhibitors (SSRIs), a newer class of antidepressants. Earlier this year,

Health Canada warned pregnant women that taking SSRIs during pregnancy

could cause serious side effects in newborns.

The new research, however, showed that pregnant women who take

anti-inflammatories -- a class of drugs that includes Advil, Motrin and

dozens of other prescription and non-prescription drugs -- also see the

risk of their child developing leukemia rise substantially. These drugs

are not currently considered teratogenic.

Dr. Infante-Rivard warned, however, that the data have to be interpreted

with caution. " The numbers are very small so we have to be careful. But

we really should be doing further research, " she said.

The study was conducted among the mothers of 780 children born with

acute lymphoblastic leukemia in the province of Quebec between 1980 and

2000. Their drug use during pregnancy was compared to that of a similar

number of women whose children did not develop the disease.

ALL, as it is known, is the most frequently diagnosed cancer in Canadian

children. There are about 250 cases a year in Canada, about 20 per cent

of all childhood cancers.

To date, little is known about its causes, except that it can be caused

by in utero exposure to X-rays and that children born with Down syndrome

are predisposed to developing that type of cancer. But the new research

suggests that taking drugs like antidepressants may be a significant factor.

The new study also offers hope that women can greatly reduce the odds

that their child will develop leukemia by taking cheap folic acid

supplements.

It is recommended that all women of childbearing age take folic acid (a

synthetic version of vitamin B-9), a micronutrient that is essential to

early neurological development of the fetus.

Getting adequate folic acid during pregnancy, meaning at least 0.4

milligrams daily, can virtually eliminate the risk that a baby will be

born with a neural tube defect like spina bifida, and greatly reduces

the risk of the childhood cancer neuroblastoma.

Folic acid is also believed to help prevent cardiovascular disease.

The new study suggests that ALL should be added to the list of

conditions that folic acid supplementation can prevent.

*

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