Scimex: An analysis of approximately 3.8 million pregnancies has revealed that
the use of antidepressants late in pregnancy may put newborns at a
slightly increased risk of a particular type of high blood pressure that
affects the arteries in the lungs, says US researchers. The condition
can be life-threatening for babies born with it, but the researchers say
that clinicians and patients will need to balance the potential small
increase in the risk for newborns with the benefits of the
antidepressants for a mother's mental health.
An analysis of approximately 3.8 million
pregnancies finds that use of antidepressants late in pregnancy may be
associated with an increased risk of persistent pulmonary hypertension
of the newborn (PPHN), according to a study in the June 2 issue of JAMA.
However, the absolute risk was small and the risk increase appears more
modest than suggested in previous studies. PPHN is a rare but
life-threatening condition that occurs when a newborn's circulation
system doesn't adapt to breathing outside the womb.
Persistent pulmonary hypertension of the newborn is associated with
substantial illness and death: 10 percent to 20 percent of affected
infants will not survive, and infants who survive face serious long-term
consequences, including chronic lung disease, seizures, and
neurodevelopmental problems. An association between selective serotonin
reuptake inhibitor (SSRI) antidepressant use during pregnancy and risk
of PPHN has been controversial since the U.S. Food and Drug
Administration issued a public health advisory in 2006. Studies that
found no increased risk tended to be small, raising the possibility that
they had insufficient power to detect an increased risk, according to
background information in the article.
Krista F. Huybrechts, M.S., Ph.D., of Brigham and Women's Hospital,
Boston, and colleagues examined the risk of PPHN associated with both
SSRI and non-SSRI antidepressants among 3,789,330 pregnant women
enrolled in Medicaid (from 46 U.S. states and Washington, D.C.; data
from 2000-2010).
Of the study population, 128,950 women (3.4 percent) used an
antidepressant during the 90 days before delivery: 102,179 (2.7 percent)
were exposed to an SSRI and 26,771 (0.7 percent) to a non-SSRI
antidepressant. Overall, 20.8 per 10,000 infants not exposed to
antidepressants during the last 90 days of pregnancy had PPHN compared
with 31.0 per 10,000 infants exposed to antidepressants. This higher
risk among exposed infants was observed for both SSRI (31.5 per 10,000
infants) and non-SSRI (29.1 per 10,000 infants) antidepressants.
Associations between antidepressant use and PPHN were decreased with
adjustment for confounders (factors that can influence outcomes that may
improperly skew the results).
"Evidence from this large study of publicly insured pregnant women may
be consistent with a potential increased risk of PPHN associated with
maternal use of SSRIs in late pregnancy. However the absolute risk was
small, and the risk increase appears more modest than suggested in
previous studies," the authors write.
"The findings in the largest cohort studied to date, using advanced
epidemiologic methods to mitigate confounding by the underlying
psychiatric illness and its associated conditions and behaviors, suggest
that the risk of PPHN associated with late pregnancy exposure to SSRI
antidepressants—if present—is smaller than previous studies have
reported. Clinicians and patients need to balance the potential small
increase in the risk of PPHN, along with other risks that have been
attributed to SSRI use during pregnancy, with the benefits attributable
to these drugs in improving maternal health and well-being."