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Antidepressants and Fetal Risk: A New Look at SSRIs During Pregnancy

Maternal use of selective serotonin reuptake inhibitors during late pregnancy raised risk for neonatal pulmonary hypertension, but individual risk-benefit profiles should be evaluated.

Depression during pregnancy is common, and women with this condition are often treated with selective serotonin reuptake inhibitors (SSRIs). Fetal risks associated with SSRI exposure have not been elucidated completely, and studies aimed at exploring risk for persistent pulmonary hypertension of the newborn (PPHN) have yielded conflicting results. Now, researchers have used birth, death, and prescription registries from 1996 to 2007 in all five Nordic countries to assess this relation in a population-based cohort study.

Among 1.6 million term and late-preterm births, absolute risk for PPHN was 0.3%. Risk for PPHN associated with SSRI use after 20 weeks of pregnancy was doubled (adjusted odds ratio, 2.1). SSRI use that was limited to early pregnancy was associated with modest excess risk for PPHN (AOR, 1.4), as was maternal history of psychiatric illness (AOR, 1.3). Risk profiles for individual SSRIs did not vary significantly.

Comment: These findings indicate that fetal exposure to SSRIs during the second and third trimesters is associated with excess risk for persistent pulmonary hypertension of the newborn, perhaps related to serotonin-mediated pulmonary vasoconstriction. However, the authors were not able to determine precisely what proportion of PPHN among offspring of SSRI users was attributable to the medication itself or to other causes (e.g., the underlying psychiatric illness). Although PPHN is a life-threatening neonatal condition, clinicians counseling women who are suffering from depression during pregnancy should keep in mind that the absolute risk for PPHN is quite low. As with any pharmacologic treatment during pregnancy, careful risk-benefit analysis is warranted — for many women with unmanageable depression, a decision not to treat could carry much greater risk to maternal and neonatal wellbeing.

— Allison Bryant, MD, MPH

Published in Journal Watch Women's Health January 19, 2012

Citation(s):

Kieler H 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 2012 Jan 12; 344:d8012. (http://dx.doi.org/10.1136/bmj.d8012)

Koren G and Nordeng H. SSRIs and persistent pulmonary hypertension of the newborn. BMJ 2012 Jan 12; 344:d7642. (http://dx.doi.org/10.1136/bmj.d7642)

Reader Remarks:

Review and add to remarks on this article

• PPHN with SSRI use
  Michelle Clardy, 23 Jan 2012 6:58 AM EST
  Specialty: Obstetrics & Gynecology
  What is the absolute risk for PPHN?

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