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Antidepressant link to persistent pulmonary hypertension

Prenatal exposure to SSRIs puts newborns at risk, say researchers

Jo Carlowe

Wednesday, 15 January 2014

Infants of mothers who take SSRIs during pregnancy are at increased risk for persistent pulmonary hypertension, according to new findings.

Results from previous studies investigating a possible link between SSRI use in pregnancy and PPHN have been mixed, so researchers in Canada set out to summarise the data and help resolve these conflicting findings. The results appear this week on bmj.com.

The authors stress that the risk is still low even in the context of SSRI exposure, but say pregnant women considering or using SSRIs and their families should be counselled about the condition.

Decisions about treatment for depression during pregnancy must consider potential risks to both the mother and the unborn baby. One potential adverse effect is persistent pulmonary hypertension of the newborn (PPHN) – high blood pressure in the lungs following birth leading to breathing difficulties. It is a rare condition, but can be severe when associated with other conditions.

The researchers examined the results of seven studies reporting PPHN with antidepressant use during pregnancy. Analysis was only possible for SSRIs, due to a lack of data on other classes of antidepressants.

Differences in study design and quality – and several known risk factors for PPHN - were taken into account.

The results suggest a small but significantly increased risk for PPHN in infants exposed to SSRIs during late pregnancy. There was no evidence of an increased risk with exposure during early pregnancy.

The risk of PPHN is typically around two births per 1,000 and the authors estimate that 286 to 351 women would need to be treated with an SSRI in late pregnancy to see one additional case of PPHN.

Future research should determine if other classes of antidepressants show similar associations, say the authors, and whether risk factors such as caesarean section, obesity, and preterm delivery, may also have an impact. They conclude depression during pregnancy must not be left untreated.

doi.org/10.1136/bmj.f6932

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