SSRI Use in Late Pregnancy Linked to PPHN, But Risk is Small
While a new study appearing in the Journal of the American Medical Association suggests that use of antidepressants in late pregnancy may be associated with an increased risk of persistent pulmonary hypertension of the newborn (PPHN), the absolute risk is small and the risk increase appears to be less than previous studies have suggested.
The Food and Drug Administration (FDA) issued a public health advisory in 2006 after a study reported that infants born to women taking SSRIs after completing the 20th week of gestation were six times more likely have PPHN compared to infants not exposed to antidepressants during pregnancy. Krista F. Huybrechts, PhD, of Brigham and Women's Hospital, Boston, and colleagues reviewed data on 3,789,330 pregnant women enrolled in Medicaid from 2000–2010 to assess the risk of PPHN and use of SSRIs and non-SSRI antidepressants during pregnancy.
A total of 3.4% of women in the sample used an antidepressant during the 90 days prior to delivery (2.7% were exposed to an SSSRI, 0.7% to a non-SSRI antidepressant). Overall, 31.0 per 10,000 infants exposed to antidepressants during the last 90 days of pregnancy had PPHN vs. 20.8 per 10,000 infants not exposed to antidepressants. This increased risk was observed among infants exposed to SSRIs (31.5 per 10,000) and non-SSRI antidepressants (29.1 per 10,000). The associations between antidepressant use and PPHN were reduced, however, when adjusted for confounders.
The authors note that the absolute risk of PPHN is small with maternal use of SSRIs late in pregnancy, and that the risk appears to be more modest than those previous suggested in earlier research. Clinicians should weigh the risks and benefits linked to SSRI use during pregnancy for each patient, they conclude.
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