Persistent pulmonary hypertension occurs rarely in newborns, and results of studies on a link between the condition and in utero exposure to antidepressants during pregnancy have been mixed. To clarify this relationship, researchers conducted a review and meta-analysis of seven studies, five with a cohort design and two case-control trials. Data limitations restricted the researchers to one class of antidepressants, selective serotonin reuptake inhibitors (SSRIs); the studies analyzed provided data on SSRI use in early pregnancy (three studies), at any point during the pregnancy (two studies), and during late pregnancy (two studies).

The use of SSRIs late in pregnancy-but not in early pregnancy-was related to a small but statistically significant increase in the risk of persistent pulmonary hypertension in newborns. The adjusted rate was 4.85 per 1,000 live births, compared with a population rate of 1.9 per 1,000, and between 286 and 351 women would need to use an SSRI in late pregnancy to result in one case of pulmonary hypertension. The authors note that, despite the elevated risk, those numbers represent a low incidence. In addition, they list a number of study limitations, such as varying definitions of early and late exposure and the lack of data on hypertension severity, and possible underlying factors, including cesarean delivery or maternal obesity.

The authors conclude that the mother's health should be considered during treatment decisions and that depression during pregnancy should be treated. Because SSRI use in late pregnancy is associated with an elevated, albeit still relatively low, risk of neonatal persistent pulmonary hypertension, neonatologists should be made aware of exposure.

REFERENCES