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Study: SSRI Use In Pregnancy Tied to Pulmonary Hypertension in Newborns

Feb 4, 2014

Use of selective serotonin reuptake inhibitors (SSRIs) by expectant mothers during their last trimester of pregnancy has been tied to increased risks for persistent pulmonary hypertension (PPH) in newborns, according to new research.

The risk, although considered low, is considered statistically significant, according to MedScape Medical News, which means the results were not due to chance. The researchers warn that “it is imperative” that the mother’s and the developing baby’s health be strongly considered in all treatment decisions. "She and her family must be counseled on both the risks of exposing the fetus to antidepressant drugs, and the risks of severe depressive illness," the researcher write. The study appeared online on January 14th in BMJ. PPH of the newborn, explain the investigators, is a rare occurrence and symptoms may include respiratory distress and hypoxia.

Lead author, Sophie Grigoriadis, MD, PhD, head of the women's mood and anxiety clinic at Sunnybrook Health Sciences Center in Toronto, Canada, and associate professor of psychiatry at the University of Toronto, told MedScape Medical News that the investigators have been involved in a large research study to better learn the risks of various treatments for depression so that a reference guide may be developed to assist clinicians and their patients when deciding on treatment options. The PPH risk with SSRIs following prenatal exposure was among the studies included in this research.

"This study makes an important contribution because the investigators quantify the effects across a number of studies instead of just summarizing them," Katrina C. Johnson, PhD, assistant professor in the Department of Psychiatry and Behavioral Sciences at Emory University in Atlanta, Georgia, told MedScape Medical News. Dr. Johnson was not involved in the research, but noted that the results are "concerning."

Another recent study, found an increased risk of developing an autism spectrum disorder (ASD) in children whose mothers took SSRIs. The team utilized the Swedish medical birth register, publicly funded screenings for ASDs, and national and regional health registers for its population-based, case-control study, said The Times. This is the second study in two years to tie antidepressant use during pregnancy with increased likelihoods of exposed children being diagnosed with autism.

“It really shouldn’t come as that much of a surprise given that numerous animal studies have shown that exposure during development leads to changes in the brain and changes in behavior—often that mimic autism,” said Dr. Adam C. Urato, assistant professor of obstetrics and gynecology at the Tufts University School of Medicine and chairman of the department of obstetrics and gynecology at MetroWest Medical Center in Framingham, Massachusetts, The Times noted. “And why should it surprise us that medications that can change brain chemistry and function might alter the development of the brain and behavior?” Dr. Urato says that the risk of taking antidepressants during pregnancy outweigh what he describes as limited benefits.

Another study suggested increased risks when taking SSRIs—Celexa, Lexapro, Paxil, Prozac, and Zoloft—during pregnancy, including potential increased risks for miscarriage; pre-term births; neonatal health complications; and long-term neurobehavioral abnormalities, including autism, according to researchers at Beth Israel Deaconess Medical Center, Tufts Medical Center, and MetroWest Medical Center.

Another study published by researchers at Sweden’s Karolinska Institute found that taking an SSRI during pregnancy was associated with a two-fold increased risk of neonatal pulmonary hypertension (PPHN). Another report published in the Archives of General Psychiatry found that babies exposed to SSRI antidepressants before birth exhibit reduced head growth at birth, and likelier to be born prematurely. And, finally, researchers at Canada’s McMaster University discovered that antidepressants that impact levels of serotonin in the brain may lead to side effects related to any bodily process normally regulated by serotonin, with possible side effects, including birth defects in infants; sexual dysfunction, and problems with sperm development in adults; diarrhea, constipation, indigestion, bloating, and other digestive problems; and abnormal bleeding and stroke in the elderly.

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