SSRI Use in Pregnancy May Double Infant’s Risk of Pulmonary Hypertension

Women who take selective serotonin reuptake inhibitors (SSRIs) while pregnant may be doubling their unborn child’s risk for persistent pulmonary hypertension, according to new research.

Helle Kieler, MD, PhD at the Karolinska University Hospital in Solna, Sweden, and colleagues conducted a population-based cohort study that included more than 1.6 million births. They discovered that SSRI exposure in the second half of pregnancy resulted in a twofold increased risk for persistent pulmonary hypertension compared to infants whose mothers did not use SSRIs. The absolute risk was 3 infants per 1,000 exposed.

Risk was similar among SSRIs, with the lowest risk associated with escitalopram (adjusted odds ratio=1.3), followed by fluoxetine, citalopram, paroxetine, and sertraline. Paroxetine had the highest adjusted odds ratio (2.8). Gestational size and caesarean delivery did not modify the effects of the medications during late pregnancy.

For the analysis, maternal health status and list of diseases during pregnancy, including psychiatric illness, was obtained. Kieler et al. also collected information on the pregnancy and birth, incidence of persistent pulmonary hypertension, and whether the woman filled a prescription for SSRIs. Researchers noted recorded whether prescriptions were ever used in pregnancy (three months before the start of pregnancy through birth), used in late pregnancy only (anytime after 140 days following the start of pregnancy through birth), or used in early pregnancy only (three months prior to pregnancy through day 55 of pregnancy).

Kieler and colleagues found that fewer women filled a prescription in late pregnancy as compared to those who filled a prescription in early pregnancy only (0.7% versus 1.1%). Antidepressant use in early pregnancy only also resulted in a slightly higher risk of persistent pulmonary hypertension. The odds ratios for specific medications ranged from 0.3 to 1.9.

“Persistent pulmonary hypertension of the newborn is a rare disease and the absolute risks for this outcome for infants to mothers using SSRIs was as low as three infants per 1000 exposed,” the authors wrote. “However, as the risk in association with treatment in late pregnancy seems to be more than doubled, we recommend caution when treating pregnant women with SSRIs.”
“It is essential to plan the treatment and to weigh the risks of persistent pulmonary hypertension of the newborn when treating women in late pregnancy with those of relapse of depression and neonatal abstinence syndrome if therapy is interrupted,” Kieler et al. added. “For women where treatment with an SSRI is the only or best option, the choice of substance seems to be of minor importance.”

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Reference:
Kieler H, Artama M, Engeland A, et al. Selective serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: population based cohort study from the five Nordic countries. BMJ. 2011; 344:d8012.