Recent years have witnessed several antidepressant medications become the subject of increasingly critical skepticism. Compounding the criticism further are reports of new evidence that lends weight tot he long-suspected link between selective serotonin reuptake inhibitors (SSRIs) and congenital birth defects. According to a new study, the risk of a child developing persistent pulmonary hypertension of the newborn (PPHN) is doubled when women receive SSRI antidepressant treatment late in pregnancy.
Persistent pulmonary hypertension of the newborn, often used synonymously with persistent fetal circulation, is a life-threatening condition that occurs in approximately two out of every 1000 live births. As its name suggests, persistent pulmonary hypertension is directly correlated to the circulatory system. PPHN is the direct result of a newborn’s circulation system being unable to adapt to breathing outside of the womb. While in the womb, the fetus obtains oxygen from the placenta through the umbilical cord. High blood pressure in the lungs forces the blood through the pulmonary artery to the other organs via a fetal blood vessel, called the ductus arteriosus.
Subsequently, after a child is born, the blood pressure in their lungs plummets significantly. The lowered blood pressure causes a drastic spike in blood flow to the lungs. After exchanging oxygen for carbon monoxide, the blood is then returned to the heart and pumped back out to the body. The ductus arteriosus constricts and permanently closes in the first day of life. However, in babies with PPHN, the pressure in the lungs remains high and the ductus arterious remains open, allowing blood to be directed away from the lungs. This creates a lack of oxygenated blood flow throughout the body which can result in life-threatening complications.
According to several studies, women exhibit an increased propensity for depression while pregnant. Subsequently, depression during pregnancy is relatively common and affects approximately 7% to 25% of all women. Due to the increased rates of depression, corresponding SSRI antidepressants experience a similar influx of use. The rate in which women began to use SSRIs called into question their safety and efficacy. During the last 15 years, six studies have assessed these concerns, resulting in inconsistent findings from no association to a six fold increased risk of PPHN. The only consistency was a lack o statistical power for a more detailed analysis, specifically the assessment of individual SSRIs.
To better understand the association between SSRI antidepressants and the development of PPHN, researchers conducted a multinational cohort study that involved more than 1.6 million births. Their primary focus was to determine the effects of specific SSRIs used late in pregnancy.
The study included women that gave birth to children in Denmark, Finland, Iceland, Norway, or Sweden between 1996 and 2007. By reviewing data obtained from their corresponding medical birth registries, prescription registries, and cause of death registries, researchers were able to compile a significant amount of relevant information. The SSRIs used during the study period were fluoxetine, citalopram, paroxetine, sertraline, fluvoxamine, and escitalopram. Popular name bran SSRI antidepressants include: Zoloft, Prozac Lexapro, Celexa, and Symbyax.
A total of 1,618,255 children were included in the cohort study. Of those children, 11,014 were exposed to SSRIs late in pregnancy while their mother received antidepressant treatment. Accordingly, the exposed infants displayed a propensity for a shorter gestational period and were classified as small for their gestational age. Among the 11,014 children that were exposed to the variety of SSRI antidepressants, 33 were diagnosed with persistent pulmonary hypertension of the newborn. Subsequently, similar tests acknowledged another 32 children diagnosed with PPHN after being exposed to SSRIs early in pregnancy.
Persistent pulmonary hypertension of the newborn is a rare condition and the absolute risk for the development of this complication in infants exposed to SSRIs was as low as three out of every 1,000 live births. However, the risk of PPHN associated with exposure late in pregnancy is significantly higher. Pregnant women who receive SSRI antidepressant treatment late in pregnancy may increase their risk of having a child with PPHN by more than two times.
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