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Clinical Summary

Prenatal antidepressant use linked to pulmonary hypertension in newborn

Takeaway

  • Exposure to antidepressants (selective serotonin reuptake inhibitors [SSRIs] and serotonin-norepinephrine reuptake inhibitors [SNRIs] during pregnancy was associated with 2-fold increase in risk for persistent pulmonary hypertension of the newborn (PPHN).
  • Sertraline was associated with the lowest risk for PPHN among SSRIs.

Why this matters

  • Clinicians treating women with depression and anxiety during pregnancy should be mindful of the apparent risk for PPHN associated with these medications and discuss the risks and benefits of antidepressants with their patients.
  • Sertraline may be the preferred option for pregnant women.

Study design

  • 11 studies involving 156,978 women and their offspring exposed to SSRIs or SNRIs during pregnancy were identified after a search on MEDLINE, EMBASE and Cochrane databases until July 2017.
  • Funding: None disclosed.

Key results

  • PPHN was detected among 452 exposed offspring (incidence rate, 2.9 cases per 1000 live births; number needed to harm, 1000).
  • Exposure to SSRI/SNRI in any trimester was associated with significant risk for PPHN in offspring (8 studies; aOR, 2.42; 95% CI, 1.68-3.48).
  • Exposure to SSRI/SNRI after week 20 was associated with significant risk for PPHN in offspring (OR, 2.08; 95% CI, 1.44-3.01).
  • Sertraline showed the lowest risk for PPHN among the SSRI agents (P-scores: sertraline, 0.83; escitalopram, 0.69; paroxetine, 0.49; citalopram, 0.21; fluoxetine, 0.16).

Limitations

  • Recall and exposure bias.
  • High heterogeneity between studies.

References


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