In the Journals

Antidepressants during late pregnancy linked to respiratory disorder in newborns

The use of antidepressants during late pregnancy may be associated with a small increased risk for persistent pulmonary hypertension of the newborn, according to recent study findings.

“Persistent pulmonary hypertension of the newborn is associated with substantial morbidity and mortality: 10% to 20% of affected infants will not survive, and infants who survive face serious long-term sequelae including chronic lung disease, seizures, and neurodevelopmental problems due to both the hypoxemia and the aggressive treatments it often requires,” Krista F. Huybrechts, MS, PhD, of the department of medicine at Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote.

Krista F. Huybrechts

Controversy has surrounded the association between selective serotonin reuptake inhibitor (SSRI) antidepressant use during pregnancy and the risk for persistent pulmonary hypertension of the newborn after a 2006 public health advisory was issued by the FDA, according to background information provided in the study.

To address this controversy, Huybrechts and colleagues assessed the risk for pulmonary hypertension of the newborn and the association with exposure to different antidepressants during late pregnancy.

The cohort study included 3,789,330 pregnant women enrolled in Medicaid across 46 U.S. states and Washington, D.C, between 2000 and 2010 from 2 months or less after the date of last menstrual period through at least 1 month after delivery. The source cohort included only those diagnosed with depression.

The researchers compared women who used SSRIs within the 90 days before delivery vs. women who did not use the therapies. Primary outcome measure was the recorded diagnosis of persistent pulmonary hypertension within the first 30 days after delivery.

According to study results, 128,950 women filled at least one prescription for antidepressants late in pregnancy, of whom 102,179 used SSRIs and 26,771 used a non-SSRI.

Compared with 31 per 10,000 infants exposed to antidepressants during the last 90 days of pregnancy who had pulmonary hypertension of the newborn, there were 20.8 per 10,000 infants not exposed to antidepressants during the last 90 days of pregnancy who had pulmonary hypertension of the newborn. The risk was higher among infants exposed to SSRIs (31.5 per 10,000 infants) and non-SSRIs (29.1 per 10,000 infants).

After restricting analysis to women with depression and adjusting for high-dimensional propensity score, the unadjusted OR for the associations between antidepressant use and pulmonary hypertension of the newborn was 1.51 (95% CI, 1.35-1.69) and 1.1 (95% CI, 0.94-1.29) for SSRIs. The OR for non-SSRIs was 1.4 (95% CI, 1.12-1.75) and 1.02 (95% CI, 0.77-1.35), respectively, according to the researchers.  

“The findings in the largest cohort studied to date, using advanced epidemiologic methods to mitigate confounding by the underlying psychiatric illness and its associated conditions and behaviors, suggest that the risk for pulmonary hypertension of the newborn associated with late pregnancy exposure to SSRI antidepressants — if present — is smaller than previous studies have reported,” Huybrechts and colleagues wrote.

“Clinicians and patients need to balance the potential small increase in the risk of pulmonary hypertension of the newborn, along with other risks that have been attributed to SSRI use during pregnancy, with the benefits attributable to these drugs in improving maternal health and well-being.”

Disclosure: The researchers report no relevant financial disclosures.  

The use of antidepressants during late pregnancy may be associated with a small increased risk for persistent pulmonary hypertension of the newborn, according to recent study findings.

“Persistent pulmonary hypertension of the newborn is associated with substantial morbidity and mortality: 10% to 20% of affected infants will not survive, and infants who survive face serious long-term sequelae including chronic lung disease, seizures, and neurodevelopmental problems due to both the hypoxemia and the aggressive treatments it often requires,” Krista F. Huybrechts, MS, PhD, of the department of medicine at Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote.

Krista F. Huybrechts

Controversy has surrounded the association between selective serotonin reuptake inhibitor (SSRI) antidepressant use during pregnancy and the risk for persistent pulmonary hypertension of the newborn after a 2006 public health advisory was issued by the FDA, according to background information provided in the study.

To address this controversy, Huybrechts and colleagues assessed the risk for pulmonary hypertension of the newborn and the association with exposure to different antidepressants during late pregnancy.

The cohort study included 3,789,330 pregnant women enrolled in Medicaid across 46 U.S. states and Washington, D.C, between 2000 and 2010 from 2 months or less after the date of last menstrual period through at least 1 month after delivery. The source cohort included only those diagnosed with depression.

The researchers compared women who used SSRIs within the 90 days before delivery vs. women who did not use the therapies. Primary outcome measure was the recorded diagnosis of persistent pulmonary hypertension within the first 30 days after delivery.

According to study results, 128,950 women filled at least one prescription for antidepressants late in pregnancy, of whom 102,179 used SSRIs and 26,771 used a non-SSRI.

Compared with 31 per 10,000 infants exposed to antidepressants during the last 90 days of pregnancy who had pulmonary hypertension of the newborn, there were 20.8 per 10,000 infants not exposed to antidepressants during the last 90 days of pregnancy who had pulmonary hypertension of the newborn. The risk was higher among infants exposed to SSRIs (31.5 per 10,000 infants) and non-SSRIs (29.1 per 10,000 infants).

After restricting analysis to women with depression and adjusting for high-dimensional propensity score, the unadjusted OR for the associations between antidepressant use and pulmonary hypertension of the newborn was 1.51 (95% CI, 1.35-1.69) and 1.1 (95% CI, 0.94-1.29) for SSRIs. The OR for non-SSRIs was 1.4 (95% CI, 1.12-1.75) and 1.02 (95% CI, 0.77-1.35), respectively, according to the researchers.  

“The findings in the largest cohort studied to date, using advanced epidemiologic methods to mitigate confounding by the underlying psychiatric illness and its associated conditions and behaviors, suggest that the risk for pulmonary hypertension of the newborn associated with late pregnancy exposure to SSRI antidepressants — if present — is smaller than previous studies have reported,” Huybrechts and colleagues wrote.

“Clinicians and patients need to balance the potential small increase in the risk of pulmonary hypertension of the newborn, along with other risks that have been attributed to SSRI use during pregnancy, with the benefits attributable to these drugs in improving maternal health and well-being.”

Disclosure: The researchers report no relevant financial disclosures.