Maternal antidepressants up infant pulmonary hypertension risk

Maternal Antidepressants Up Infant Pulmonary Hypertension
Maternal Antidepressants Up Infant Pulmonary Hypertension

HealthDay News -- Pregnant women who take antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), may be increasing their child's risk for persistent pulmonary hypertension of the newborn, data indicate.

Taking SSRIs in late pregnancy was associated with doubling the odds of persistent pulmonary hypertension of the newborn (OR 2.1, 95% CI 1.5 to 3.0), Helle Kieler, M.D., Ph.D., of the Karolinska Institute in Stockholm, Sweden, and colleagues reported online first in BMJ.

"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," the researchers wrote.

They evaluated data from more than 1.6 million infants from the national health registers of five Nordic countries and found that 30,000 women had used SSRIs during pregnancy from 1996 to 2007, 11,014 of whom had been prescribed an SSRI after gestational week 20.

Exposure to SSRIs in late pregnancy increased the absolute risk of persistent pulmonary hypertension from 1.2 to  three per 1,000 liveborn infants (OR=2.1, 95% CI=1.5 to 3.0), the researchers found. This risk remained even after adjusting for maternal age, dispensed nonsteroidal anti-inflammatory drugs and diabetes medications, preeclampsia, chronic illnesses during pregnancy, country of birth, birth year, level of delivery hospital, and birth order.

Increased risks for specific SSRIs including sertraline, citalopram, paroxetine and fluoxetine, were similar in magnitude, the researchers noted. Filling a prescription for an SSRI before gestational week eight was associated with slightly increased risk (adjusted OR=1.4; 95% CI=1.0 to 2.0).

The researchers proposed the possible mechanism underlying the relationship between prenatal exposure to an SSRI and the newborn condition could involve the accumulation of SSRIs in the lungs combined with the ability of serotonin to cause vasoconstriction and to mediate pulmonary arterial smooth muscle cell proliferation.

Other antidepressants that affect serotonin or norepinephrine activity have also been associated with persistent pulmonary hypertension in the newborn, supporting a possible causal role for serotonin, the researchers added.

Study limitations include the inability to determine whether filled prescriptions were used and the lack of an assessment to determine possible exposure to more than one antidepressant.

Kieler H et al. BMJ 2012; doi:10.1136/bmj.d8012.

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