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#Grand Rounds

Does SSRI Exposure in Utero Increase Risk for Persistent Pulmonary Hypertension in Newborns?

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BACKGROUND AND PURPOSE:

  • Selective serotonin reuptake inhibitors (SSRIs) include
    • Fluoxetine | Paroxetine | Sertraline | Citalopram | Escitalopram | Fluvoxamine
  • Serotonin norepinephrine reuptake inhibitors (SNRIs) include
    • Venlafaxine
  • Associations have been identified between SSRIs and adverse fetal outcomes including persistent pulmonary hypertension of the newborn (PPHN)
  • PPHN relatively rare with 2–6 cases per 1000 live births
  • Regulatory agencies’ guidance
    • FDA: Cannot draw conclusions regarding SSRI and PPHN
    • UK Regulatory Body: SSRIs associated with increased risk for PPHN >20 weeks | No clear conclusion for SNRIs
  • Masarwa et al. (AJOG, 2018) assessed whether exposure to SSRIs and SNRIs increased risk of PPHN

METHODS:

  • Systematic review and meta-analysis
    • Retrospective cohort studies | Case-control studies
    • Studies included risks for PPHN
  • Exposures: SSRI or SNRI in pregnancy
  • The primary outcome: Risk for PPHN

RESULTS:

  • 11 studies |156,978 women and offspring
  • 452 cases of PPHN
    • Incidence rate: 2.9 cases per 1000 live births
  • The risk for persistent pulmonary hypertension of the newborn was significantly increased after exposure to SSRI/SNRI
    • Exposure in any trimester: Odds ratio (OR) 1.82 (95% CI, 1.31–2.54)
    • Exposure only >20 weeks: OR 2.08 (95% CI, 1.44–3.01)
  • Of the SSRIs, sertraline was ranked most likely to have the lowest risk for persistent pulmonary hypertension of the newborn (P = .83)

CONCLUSION:

  • Exposure to SSRI/SNRI during gestation increased the risk of persistent pulmonary hypertension in newborns
  • Sertraline associated with the lowest risk (percentage of drug that crosses placenta is lower than others)

Learn More – Primary Sources:

Prenatal exposure to selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors and risk for persistent pulmonary hypertension of the newborn: a systematic review, meta-analysis, and network meta-analysis

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Related ObG Topics:

Outcomes and Mode of Delivery in Pulmonary Hypertension
Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations
Are NSAIDs Associated with Persistent Postpartum Hypertension in Women with Preeclampsia?

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