New research shows that maternal use of SSRI antidepressants late in pregnancy is linked to increased risk for persistent pulmonary hypertension (PPH) in newborns.
A meta-analysis of seven studies shows a significant association between PPH – increased pressure in the pulmonary arteries – in infants whose mothers used selective serotonin reuptake inhibitors (SSRIs) during the last trimester of pregnancy, Medscape Medical News reports.
“The risk difference, which is something we wanted to look at for clinicians, was 3 per 1000 infants,” according to lead author Sophie Grigoriadis, MD, PhD, who is head of the women’s mood and anxiety clinic at Sunnybrook Health Sciences Center in Toronto, Canada, and associate professor of psychiatry at the University of Toronto. There was no association found between newborn PPH and SSRI exposure during early pregnancy, according to Medscape Medical News.
The researchers stress that it is “imperative” to weigh the mother’s health as well as that of the fetus in treatment decisions, balancing the risks of exposing the fetus to SSRI antidepressant drugs and the risk of severe depression in the mother. The study was published online on January 14, 2014 in the British Medical Journal (BMJ).
PPH in newborns occurs in about 1.9 per 1000 live births, and symptoms can include respiratory distress or hypoxia (reduced oxygen). The U.S. Food and Drug Administration (FDA) and Health Canada issued advisories to clinicians in 2006 about the possible link between maternal SSRI use and PPH in newborns. In 2011, the FDA said it was too early to reach a conclusion about the link. Dr. Grigoriadis says the investigators have been engaged in a large research program to understand the risks of various treatments and “develop a reference guide to help clinicians and their patients make more informed treatment decisions,” according to Medscape Medical News. The risk for PPH after prenatal exposure to SSRIs is one of the areas of this research.
The meta-analysis examined seven English-language studies that met the inclusion criteria. All of the infants were at least 33 to 34 weeks gestation, with no preterm births included. Results showed a significantly increased risk for PPH in newborns exposed to SSRIs in late pregnancy (odds ratio [OR], 2.50; 95% confidence interval [CI], 1. 32 – 4.73; P = .005) but not for those exposed during early pregnancy (OR, 1.23).