Practice

Reason for posting: Major depressive disorders affect one in 10 women of re-productive age, and selective serotonin reuptake inhibitors (SSRIs), with their generally favourable efficacy and safety profiles, are the most common medica-tions used to treat these conditions. However, the results of a recent case– control study suggest that women tak-ing the drugs in the latter half of their pregnancy may have an increased risk of their offspring developing persistent pulmonary hypertension of the new-born (PPHN).1 The drugs: PPHN is a rare but serious and sometimes fatal (about 10%–20% of the time) respiratory condition (Box 1, Box 2). In the current study, 377 women who delivered children with PPHN were enrolled. They were matched to 836 control women and their infants who did not have PPHN. Six months after delivery the women were asked to identify medications used in pregnancy, health history and demo-graphic variables including age, ethnic-ity, number of years of education, presence of diabetes, cigarette use, pre-pregnancy body mass index (BMI) and their infant’s sex. The results showed use of the antidepressants in general (and SSRIs specifically) before 20 weeks ’ gestation was not associated with PPHN. However, after adjusting for maternal ethnicity, BMI and dia-betes, women using SSRIs after 20 weeks ’ gestation were more likely to have a child with PPHN than matched controls (adjusted odds ratio [OR] 6.1, 95 % confidence interval [CI] 2.2–16.8). Adjustment for factors such as smok-ing, alcohol intake and use of NSAIDs did not change the results. Of note, only about one in 20 children with PPHN had mothers who used antidepressants during their pregnancy (a proportion similar to the control group). SSRIs used included citalopram, fluoxetine, paroxetine and sertraline. The potential mechanism of this ad-verse effect is not certain, but SSRIs, which pool in the fetal lungs, may ini-hibit nitric oxide synthesis.1 Alterna-tively, increased serotonin levels may vasoconstrict pulmonary vessels, or cause pulmonary smooth muscle cell proliferation and increased pulmonary vascular resistance.1D