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Prenatal SSRI Exposure in Late Pregnancy Linked to Persistent Pulmonary Hypertension in Newborns — Physician’s First Watch

Medical News |
January 15, 2014

Prenatal SSRI Exposure in Late Pregnancy Linked to Persistent Pulmonary Hypertension in Newborns

By Amy Orciari Herman

Prenatal exposure to SSRIs during late pregnancy is associated with increased risk for persistent pulmonary hypertension of the newborn, according to a BMJ meta-analysis.

Researchers, pooling data from seven observational studies, found no association between prenatal SSRI exposure in early pregnancy and persistent pulmonary hypertension. However, exposure in late pregnancy (at roughly 20 weeks' gestation or later) conferred more than a doubling of risk (odds ratio, 2.5), which could not be explained by confounders such as congenital malformations or meconium aspiration.

The researchers estimate that roughly 300 women would need to receive an SSRI in late pregnancy for one additional case of persistent pulmonary hypertension to occur.

Deborah Cowley, a psychiatrist with NEJM Journal Watch, commented: "This study confirms prior reports of the increased risk of persistent pulmonary hypertension of the newborn with late-pregnancy SSRI exposure (although less than the 6-fold risk originally reported) and the need to inform patients of this risk."

Reader Comments (3)

Gail Erlick Robinson MD, FRCP Physician, Psychiatry, University of Toronto

The concerns about PH of the newborn need to be kept in perspective. The authors note that they were unable to study some factors that are known to affect the occurrence of PH such as Caesarian section and prematurity. As well, the authors themselves state: "The absolute risk of persistent pulmonary hypertension of the newborn remains low even in the context of exposure to SSRIs in late pregnancy
Given that persistent pulmonary hypertension of the newborn occurs in about 1.9/1000 livebirths, about 286 to 351 women would need to be treated with an SSRI during late gestation to result in an average of one associated case of persistent pulmonary hypertension of the newborn". Statistical risk is not the same as clinical risk. On the other hand, the risk of negative cosequences of depression during pregnancy are well documented including poor prenatal attendence, poor eating, insomnia, substance use and suicidal behaviour. I have treated over a 1000 women with SSRIs throughout pregnancy and never had a case of PH of the newborn.

Brian Craig Physician, Psychiatry, New Zealand

A cautionary tale and needs to be taken seriously as SSRIs very frequently used in pregnancy.

Neves Physician, Pediatric Subspecialty, Neonatal intensive care Unit

I have been observed at least 2 cases of neonatal pulmonary hipertension caused by SSRI exposure. The two cases ocurred after the pregnant women intaked in the last week of gestation proxetine for 6 days.
Thanks by the information

Luiz Neves Neonatologist.

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