Does SSRI Use During Pregnancy Increase the Risk for PPHN?
Robin Steinhorn, MD reviewing Huybrechts KF et al. JAMA 2015 Jun 2.
Yes, though perhaps more modestly than previously suggested.
Neonatal persistent pulmonary hypertension (PPHN) presents as critical hypoxemia during the first few days of life and is associated with significant morbidity, mortality, and expense. Some population-based studies suggest that selective serotonin reuptake inhibitor (SSRI) use increases the risk for PPHN, though other studies have been unable to confirm this association.
To investigate this issue further, researchers analyzed data from a linked cohort of pregnant women and infants enrolled in Medicaid between 2000 and 2010 in 46 U.S. states and the District of Columbia. Of 3,789,330 women, 128,950 (3.4%) used an antidepressant during the 90 days before delivery, including 102,179 (2.7%) who used SSRIs and 26,771 (0.7%) who used non-SSRI antidepressants.
After limiting the analysis to women with a diagnosis of depression, the risk for PPHN was 24.9 (95% confidence interval, 23.7–26.1) per 10,000, 33.8 (95% CI, 29.7–38.6), and 34.4 (95% CI, 26.5–44.7) for infants who were unexposed, exposed to SSRIs, and exposed to non-SSRI antidepressants, respectively. Associations between antidepressant use and PPHN risk were lessened after controlling for potential confounding variables. For SSRIs, the unadjusted and adjusted odds ratios were 1.51 (95% CI, 1.35–1.69) and 1.10 (95% CI, 0.94–1.29), respectively.
Citation(s):
Huybrechts KF et al. Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA 2015 Jun 2; 313:2142.
