A study published today in JAMA, suggests that use of antidepressants late in pregnancy may be associated with a small increased risk of persistent pulmonary hypertension of the newborn (PPHN).
PPHN is a rare condition that occurs when a newborn's circulation system in its lungs doesn't adapt to breathing outside the womb. It is a severe condition associated with a 10% - 20% mortality rate and long term health consequences including chronic lung disease, seizures, and neurodevelopmental problems
The study, conducted by Brigham and Women’s Hospital in Boston, examined the risk of PPHN associated with both SSRI and non-SSRI antidepressants among 3,789,330 pregnant women.
Of the study population, 3.4% of women used an antidepressant during the 90 days before delivery: 2.7% were exposed to an SSRI and 0.7% to a non-SSRI antidepressant. Overall, 20.8 per 10,000 infants not exposed to antidepressants during the last 90 days of pregnancy had PPHN compared with 31.0 per 10,000 infants exposed to antidepressants. This higher risk among exposed infants was observed for both SSRI (31.5 per 10,000 infants) and non-SSRI (29.1 per 10,000 infants) antidepressants.
Associations between antidepressant use and PPHN were decreased with adjustment for confounders.
Commenting on the study, Dr Patrick O’Brien, spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG) said:
“This is an extremely useful study, examining nearly 3.8 million pregnancies, it is the largest study on this issue to date. It has used a robust methodology and careful efforts have been made to account for any confounding factors. The findings therefore, are certainly the best evidence we currently have on antidepressant use in late pregnancy and the risk of PPHN.
“In a sense, these results are reassuring. The findings suggest a very small absolute risk. The chances of a baby getting PPHN when its mother was not taking an SSRI are around 2 in 1000, compared to around 3 in 1000 when the mother had taken an SSRI antidepressant medication in the last 90 days of pregnancy.
“Depression in pregnancy can be very serious for a woman and can also impact on the health of her baby, so we must consider the benefits of antidepressant medication in such cases.
“Our continued advice for pregnant women suffering with depression would be that the benefits outweigh the risks, however, all pros and cons should be discussed and weighed up by a woman, together with her obstetrician.”
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