SSRI Use in Late Pregnancy Ups Risk of Infant Pulmonary Hypertension but Overall Risk Remains Low

The risk of persistent pulmonary hypertension developing in infants whose mothers took a certain class of antidepressants in late pregnancy is low, according to the results of a recent meta-analysis.

In reporting the findings, the authors stressed that the risk was low enough that it should not necessarily persuade pregnant women to avoid taking selective serotonin reuptake inhibitors (SSRIs).

“Depression during pregnancy must not be left untreated, as the potential for untoward effects is not negligible and can extend into the postpartum period,” the authors wrote. “Selection of treatment is based on several factors, and antidepressant drugs may be necessary, especially in severe depressive episodes. Although the odds for persistent pulmonary hypertension of the newborn seem to be greater with the use of SSRIs later in pregnancy, despite the limitations of the original studies, the risk is still low.”

Instead, the authors suggested that expectant mothers be counseled about the risk of SSRI exposure late in pregnancy. Any such discussion should also include information on how persistent pulmonary hypertension in infants can be managed successfully if it does occur.

The analysis, which included 7 studies, found that exposure to SSRIs in early pregnancy was not associated with persistent pulmonary hypertension of the newborn (odds ratio, 1.23; 95% confidence interval, 0.58 to 2.60; P=0.58). However, exposure in late pregnancy was associated with the condition (OR, 2.50; CI, 1.32 to 4.73; P=0.005).

The absolute risk difference for the development of persistent pulmonary hypertension in infants after maternal use of SSRIs in late pregnancy was 2.9 to 3.5 per 1000 infants. The authors estimated 286 to 351 women would need to be treated with an SSRI in late pregnancy to result in an average of 1 additional case of persistent pulmonary hypertension in a newborn.

Pertinent Points:
- There is a low but significantly increased risk of persistent pulmonary hypertension developing in newborns whose mothers used SSRIs late in pregnancy.
- Pregnant women with depression should be counseled about this risk, but these findings should not prevent pregnant women from taking needed antidepressants.

References:

Reference
Grigoriadis S, VonderPorten EH, Mamisashvili L, et al. Prenatal exposure to antidepressants and persistent pulmonary hypertension of the newborn: systematic review and meta-analysis. BMJ. 2014;348:f6932.