SSRIs During Late Pregnacy and Infant Pulmonary Hypertension

Sophie Grigoriadis, MD, MA, PhD, FRCPC Head, Women's Mood and Anxiety Clinic:  Reproductive Transitions, Fellowship Director, Sunnybrook Health Sciences Centre, Scientist, Sunnybrook Research Institute Adjunct Scientist, Women's College Research Institute, Associate Professor, Faculty of Medicine, University of TorontoMedicalResearch.com Interview with:
Sophie Grigoriadis, MD, MA, PhD, FRCPC
Head, Women’s Mood and Anxiety Clinic:  Reproductive Transitions,
Fellowship Director, Sunnybrook Health Sciences Centre,
Scientist, Sunnybrook Research Institute
Adjunct Scientist, Women’s College Research Institute,
Associate Professor, Faculty of Medicine, University of Toronto

MedicalResearch.com: What are the main findings of the study?

Dr. Grigoriadis: Infants of women exposed to selective serotonin reuptake inhibitors (SSRIs) during late pregnancy (but not early) are at risk for developing persistent pulmonary hypertension of the newborn (PPHN). PPHN is a condition in which blood pressure remains high in the lungs following birth and which results in breathing difficulties.  The symptoms can range from mild to severe, but the condition can be managed successfully typically after SSRI exposure. It is important to note that the baseline risk for PPHN in the general population is low (about 2 per 1,000 live births), and so the increase in risk with SSRIs still represents a low overall risk for developing PPHN following SSRI exposure in late pregnancy (increasing to approximately 5 per 1,000 live births). This increased risk means that 286 to 351 women would have to be treated with an SSRI during late pregnancy in order to result in 1 additional case of PPHN.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Grigoriadis: The findings of this study were not wholly unexpected, although the research evidence had been mixed prior to our meta-analysis. More surprising, was that we did not find a moderating effect for any of the known risk factors for PPHN that we were able to examine (i.e., meconium aspiration or congenital malformations) but this may be a reflection of the fact that there were few studies and the way these studies handled the risk factors.

MedicalResearch.com What should clinicians and patients take away from your report?

Dr. Grigoriadis: Women and their families should be counseled about PPHN and the potential for the development of it following exposure to SSRIs during late pregnancy although the risk remains low.  As well, women and their families must know that the condition can often be managed favorably if PPHN does occur. Clinicians should be aware of the risk and clinical presentation of PPHN in the infant.  Depression should not be left untreated as there are risks for untreated depression for both the mother and baby that can also extend into the postpartum period.   Various treatment options exist for depression; treatment selection is based on several factors and sometimes antidepressant drugs are needed.

MedicalResearch.com What recommendations do you have for future research as a result of this study?

Dr. Grigoriadis: Future research should determine whether other classes of antidepressants, besides SSRIs, also show an association with PPHN, as well as whether known risk factors (i.e., preterm delivery, c-section or obesity) and if clinical depression itself play a role in any association. Antidepressants are also prescribed for other psychiatric disorders that may also have an independent association with development of PPHN and thus psychiatric diagnosis should also be identified. Furthermore, future research in this field would benefit from a more uniform definition of early and late antidepressant exposure, and from studies in which exposure to the medication under examination is more assured. This last point speaks to the fact that reliance upon prescription database registries or retrospective self-report of exposure may mean that women categorized as exposed may not have been done so accurately. Lastly, it is important that future studies examine the severity of PPHN and the factors important for those with increased severity.

Citation:
Prenatal exposure to antidepressants and persistent pulmonary hypertension of the newborn: systematic review and meta-analysis