A group of researchers led by Dr. 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, performed a total of 7 meta-analyses based on available data resources, determining the effects of the maternal anti-depressant Selective Serotonin Reuptake Inhibitor (SSRI) on pregnancy and child health. She and her research team concluded that usage of SSRIs during the third trimester of pregnancy led to a low but significant risk of Persistent Pulmonary Hypertension in the Newborn (PPHN). It is to be noted that no such relationship was found during the early stages of pregnancy.
PPHN is a congenital condition marked by failure of normal circulatory transition in newborns. Normally, blood vessels in infants relax after delivery, but in case of PPHN, the resistance persists and pressure on the right side of the heart is more than that on the left side. It leads to a right-to-left cardiac shunt with a one-way vulvular opening (which would be patent foramen oval or patent ductus arterioles). Hence, with irregular blood flow, PPHN can lead to one of many conditions, including pulmonary underdevelopment, inadequate pulmonary perfusion, and refractory hypoxemia. The diagnosis for PPHN is also based on the right-to-left cadiac shunt with a persistent one-way vulvular opening and the absence of congenital heart disease.
According to a report published in the online edition of the BMJ, January 14, 2014, the data available for this study was only for the SSRI class of anti-depressants and not any other medication. Moreover, this study was a part of a larger study meant to guide expecting mothers about the various side-effects associated with different classes of medication available during pregnancy, to help them make a conscious decision in terms of medicines. A similar step had been initiated by health Canada and the US FDA from 2006 till 2011 to help form a list of guidelines for physicians dealing with pregnant women, but due to insufficient and conflicting data regarding the use of SSRIs during pregnancy, a concrete decision could not be taken.
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In this case, the study concluded that the rate of risk of an infant being diagnosed with PPHN at birth was very low, almost 2 per 1000 births. The study also stated that for every extra case of PPHN, around 286 to 351 mothers would be needed to be treated with SSRI in their third trimester of pregnancy (33 to 34 weeks of gestation). Additionally, as many as 2,288 women needed to be treated with SSRIs in their early stage of pregnancy.
Hence, although a low absolute risk difference was observed in the course of this study, it is equally important to remember that the findings are still significant. Researchers say that in the case of maternal depression, adequate counseling is required along with proper knowledge of the side effects of medications taken during this time.
The researchers concluded that, “It is imperative that the mother’s health be weighed heavily in 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. Pregnant women considering or using SSRIs and their families should be educated about persistent pulmonary hypertension of the newborn, how the symptoms can range in severity, what treatments are available for it at the institution where the birth will take place, and that it can typically be managed successfully if it does occur in the context of SSRI use.”