Taking certain antidepressants later in pregnancy may slightly increase the risk of a rare but life-threatening respiratory disease known as persistent pulmonary hypertension of the newborn (PPHN), according to a study published yesterday in JAMA.
The overall risk increase was modest, though, and only significant among full-term births.
In 2006, the Food and Drug Administration (FDA) issued a public health advisory related to the possible risk of PPHN in pregnant women taking selective serotonin reuptake inhibitor (SSRI) antidepressants. Subsequent research produced conflicting results and negative studies tended to be small, raising the possibility that they may not have been able to detect an increased risk, prompting the FDA to revise and soften their stance in 2011.
Researchers at Brigham and Women’s Hospital examined the medical records of nearly 4 million women enrolled in Medicaid—over 128,000 of whom were taking an antidepressant during the 90 days before delivery. Overall, 7,630 infants not exposed to antidepressants were diagnosed with PPHN (~20.8 per 10,000 births) compared with 322 infants exposed to SSRIs (~31.5 per 10,000 births) and 78 infants exposed to other antidepressants (~29.1 per 10,000 births).
After adjusting for other potential risk factors, the use of SSRIs resulted in a 28 percent increased risk for PPHN among full-term births; other antidepressants were not associated with any increased risk. The study authors did stress that the risk identified was less than in previous studies, and given the rarity of PPHN, the absolute disease risk remained very small.
"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," the study authors write.
To read about other reported health risks of SSRI use during pregnancy, see the Psychiatric News articles “Certain Cardiac Abnormalities Not Linked to Prenatal Antidepressant Use, Study Finds” and “Verdict Mixed on Autism Link to SSRI Use in Pregnancy.” For more on SSRIs and PPHN, see the American Journal of Psychiatry article “Persistent Pulmonary Hypertension of the Newborn and Selective Serotonin Reuptake Inhibitors: Lessons From Clinical and Translational Studies.”
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