Persistent Pulmonary Hypertension of the Newborn Is Associated with Mode of Delivery and Not with Maternal Use of Selective Serotonin Reuptake Inhibitors

Abstract

We sought to determine if maternal use of selective serotonin reuptake inhibitors (SSRIs) in the second half of pregnancy is associated with persistent pulmonary hypertension of the newborn (PPHN). We performed a case-controlled study (1:6 ratio) of infants delivered at Madigan Army Medical Center with primary PPHN from 2003 through 2009. Study and control patients were compared for the following clinical factors: SSRI use after 20 weeks gestation, mode of delivery, maternal disease, body mass index, tobacco use, fetal gender, maternal age, and parity. We identified 20 cases of primary PPHN out of 11,923 births for an incidence of 0.17%. Mode of delivery was the only factor we found to be associated with PPHN. Specifically, cesarean delivery (CD) prior to the onset of labor increased the risk for PPHN: odds ratio (OR) = 4.9, confidence interval (CI) 1.7 to 14.0. Importantly, use of SSRIs in the second half of pregnancy was identified in 5% of the controls but none of the cases (OR = 0, CI 0 to 3). PPHN is associated with CD prior to the onset of labor but not with SSRI use in the second half of pregnancy. Previous studies linking PPHN to SSRI use relied on after-the-fact patient interviews and incomplete records. Additional studies are needed to verify these results.

Antidepressant Use Late in Pregnancy and Risk of Persistent Pulmonary Hypertension of the Newborn

“…7,8 Based on a review of additional studies with conflicting findings (2 studies reported an increase in risk, whereas 3 did not), the FDA concluded in 2011 that it was premature to reach any conclusion about a possible link between SSRI use in pregnancy and PPHN and updated the advisory accordingly. [9][10][11][12][13] The negative studies tended to be small, raising the possibility that they had insufficient power to detect an increased risk. 10,11 Given the ongoing controversy regarding the association between SSRI exposure in late pregnancy and the risk of this highly morbid pregnancy outcome, we examined the risk of The approach used for the development of our study cohort has previously been described in detail.…”

Idiopathic Pulmonary Arterial Hypertension in Children: A Review

“…Normally, PVR drops by half within the first two days of life in full-term newborns. Failure of PVR to drop is associated with multiple factors such as abnormal lung development, maldevelopment of the pulmonary vasculature, premature delivery, mode of delivery, meconium aspiration, maternal fever, maternal pulmonary disease and maternal use of selective serotonin update inhibitors [60][61][62]. In older children with IPAH, intimal hyperplasia and occlusive changes are found in pulmonary arterioles.…”

Pharmacotherapy of obsessive-compulsive disorder during pregnancy: a clinical approach

“…48,49,64 Data are also conflicting regarding the relationship between antenatal antidepressant exposure and other neonatal outcomes such as spontaneous abortion, birth weight, persistent pulmonary hypertension, and autism spectrum disorders. 23,26,35,47,[50][51][52][53][54][55][56][57]60,[65][66][67][68][69] Specific information on the risk of other neonatal outcomes in fetuses exposed to clomipramine is lacking. The limited available data suggest that similar to SSRIs, TCAs may be associated with PTB and PNAS.…”