Understanding the Risks of Antidepressant Use during Pregnancy

August 20, 2015 Brigham and Women's Hospital

New research suggests that antidepressant use in late pregnancy doesn't significantly increase risk of persistent pulmonary hypertension in newborns.

According to the U.S. Department of Health and Human Services, about 13 percent of pregnant women and new mothers may experience depression. Antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs) are an effective treatment for depression. However, their use during late pregnancy has raised concerns, due to questions about the health impact on newborns.

A 2006 study suggested that the use of antidepressants in late pregnancy (after 20 weeks) may increase the risk of persistent pulmonary hypertension of the newborn (PPHN). PPHN is a condition that typically occurs in term or near-term infants and presents within hours of birth. It can lead to severe respiratory failure requiring intubation and mechanical ventilation.

To more fully understand the association between the risk of PPHN and exposure to antidepressants during late pregnancy, researchers from Brigham and Women’s Hospital (BWH) and the Harvard T.H. Chan School of Public Health examined the health records of more than 3.7 million publicly insured pregnant women across the United States.

Researchers found that the frequency of PPHN was lower among infants who were not exposed to antidepressants during the last 90 days of pregnancy, compared to infants who were exposed to either SSRI or non-SSRI antidepressants:

  • No exposure – 20.8 per 10,000 infants
  • SSRI antidepressant exposure – 31.5 per 10,000 infants
  • Non-SSRI antidepressant exposure – 29.1 per 10,000 infants

After accounting for differences in the characteristics of women who did and did not take antidepressants, there was no longer a significant increase in the risk of PPHN associated with SSRI or non-SSRI antidepressants.

The researchers concluded that the increase in absolute risk of developing PPHN associated with maternal use of antidepressants in late pregnancy is small and appears to be more modest than suggested in previous studies.

“Clinicians and patients need to balance the potential small increase in the risk of PPHN, along with other risks that have been attributed to SSRI use during pregnancy, with the benefits of these drugs in improving the mother’s health and well-being,” says Krista Huybrechts, MS, PhD, corresponding author of the study and epidemiologist in the Division of Pharmacoepidemiology and Pharmacoeconomics at BWH.

The results of the study were published in JAMA, the Journal of the American Medical Association.

- Elaine S./Jamie R.
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