Mother's Depression Rx May Affect Newborn Lungs

SSRI antidepressants in late pregnancy increased risk of newborn pulmonary hypertension

(RxWiki News) Some newborns have breathing problems after birth, and according to a recent study, antidepressants taken during pregnancy may have a small role in these breathing problems.

Recognizing and treating depression in pregnant women is important. Since several individual scientific reports have provided different conclusions about the risks of lung issues in newborns following antidepressant use in mothers, a research team from Canada summarized and analyzed the data from many studies in a scientific review.

This team concluded that a type of antidepressants, called selective serotonin reuptake inhibitors (SSRIs), taken by a pregnant woman late in pregnancy increased the odds of persistent pulmonary hypertension (high blood pressure in the lungs) in their newborns. These researchers did not observe the same results when SSRIs were taken early in pregnancy.

"Tell your obstetrician about any medications you are taking."

Sophie Grigoriadis, MD, PhD, a researcher affiliated with the University of Toronto and Sunnybrook Research Institute in Toronto, Canada, and her team conducted this review of research into antidepressant use by pregnant women and the incidence of persistent pulmonary hypertension.

Persistent pulmonary hypertension is a condition that exists in newborns when the lung blood vessels that usually relax at birth stay constricted. This increases the blood pressure in the vessels, decreases the infant’s blood oxygen and can cause breathing difficulties that can be so severe as to require intensive medical intervention.

The researchers reviewed 738 published research articles and found seven studies that reported on persistent pulmonary hypertension in newborns after the pregnant mother took antidepressants. The seven studies had comparison groups of women who had not taken antidepressants while they were pregnant.

The seven published studies had data on the use of SSRIs and allowed the researchers to compare use of this class of antidepressants on persistent pulmonary hypertension in newborns.

The researchers found no significant risk of a newborn developing persistent pulmonary hypertension if the mother had taken SSRIs in early pregnancy.

From the data in the different studies analyzed, Dr. Grigoriadis and her team calculated that if a pregnant woman took SSRIs late in pregnancy, her newborn had 2.5 times the risk of developing persistent pulmonary hypertension as newborns born to mothers who did not take SSRIs.

The research team stressed that the risk of persistent pulmonary hypertension is usually very low, with about 1.9 newborns out of every 1,000 affected. Taking SSRIs in late pregnancy resulted in a finding of persistent pulmonary hypertension in 2.9 to 3.5 newborns per 1,000 births.

The increased risk found in this review meant that one additional newborn could be expected to develop persistent pulmonary hypertension for every 286 to 351 women treated with SSRIs late in their pregnancy.

In conclusion, the authors emphasized the importance of treating depression in pregnant women and recognizing the increased, but still low, risk for the development of persistent pulmonary hypertension in infants whose mothers took SSRIs late in pregnancy.

"When discussing the treatment of depression in pregnancy with experts, they have often portrayed the decision to medically treat or not treat as a 'risk-risk' decision – that is, a calculation about the risk of treatment versus the risks of untreated depression," said Aaron Krasner, MD, a board certified Child/Adolescent and Adult Psychiatrist at Silver Hill Hospital in New Canaan, CT.

"While evidence for psychosocial treatments, especially Interpersonal Psychotherapy (ITP), exists for severely depressed expectant mothers, the risk of not treating can outweigh the relatively small risk of [persistent pulmonary hypertension in newborns] portrayed in this study," Dr. Krasner told dailyRx News.

Several limitations of this research review were noted by the authors. Because there was no data on other antidepressants, only SSRIs could be analyzed in this study. The definitions used by authors of the seven studies used slightly different ranges for what they considered early and late pregnancy and they did not assess the severity of the persistent pulmonary hypertension. Dr. Grigoriadis and her team noted that maternal obesity, as well as whether an infant was delivered by caesarean, might be factors that contributed to the lung disorder that were not considered in these studies.

This research review was published in the January issue of BMJ.

Funding for this research was provided by a grant from the Canadian Institutes of Health Research and the Ontario Ministry of Health and Long-Term Care through the Drug Innovation Fund.

Dr. Grigoriadis disclosed that she received honorariums for lectures, consulting and advising from Servier and Lundbeck and additional research support from the CR Younger Foundation.

Review Date: 
January 14, 2014