But, overall risk of 'persistent pulmonary hypertension' remains low, study finds
By Serena Gordon
WEDNESDAY, Jan. 15, 2014 (HealthDay News) -- Taking certain antidepressants in late pregnancy more than doubles the odds of a lung complication in newborns, a new review says.
Fortunately, the study also found that the absolute risk of the complication -- known as persistent pulmonary hypertension -- was still low, affecting about 3.5 out of every 1,000 births, according to study author Dr. Sophie Grigoriadis.
"Women taking these medications in pregnancy should not panic. The risk is still quite low. It should be one of the factors you consider when you decide to use medications, but it has to be balanced with the potential problems that can occur if you don't treat depression," said Grigoriadis, head of the Women's Mood and Anxiety Clinic: Reproductive Transitions at Sunnybrook Health Sciences Center, in Toronto.
Deciding how to treat depression during pregnancy can be difficult, the study noted. The benefits of antidepressants have to be weighed against potential harms, and compared to the potential risks of untreated depression.
Untreated depression in a pregnant woman can lead to unhealthy eating habits, poor weight gain, high blood pressure, inadequate prenatal care and possible drug and alcohol abuse, according to the March of Dimes.
Dr. Ariela Frieder, who specializes in reproductive psychiatry at Montefiore Medical Center in New York City, said that untreated depression in pregnancy can lead to low birth weight and premature birth. She said it's also been linked to lower intelligence and behavioral problems as the children grow up. In addition, depression in pregnancy is more likely to lead to postpartum depression.
"You need to be OK during pregnancy to be OK during the postpartum period," Frieder said.
Persistent pulmonary hypertension is a known risk related to taking the antidepressants known as selective serotonin reuptake inhibitors (SSRIs). This class of medications includes fluoxetine (Prozac), sertraline (Zoloft), venlafaxine (Effexor) and paroxetine (Paxil).
For a baby with persistent pulmonary hypertension, instead of the lungs relaxing after birth, they become resistant. That means they don't expand as they should, and the result is the baby takes in less oxygen than normal.
Treatments are available for persistent pulmonary hypertension, and most babies with the condition do well, according to Grigoriadis. But, she said that long-term risks are an area that needs more research.
The new study, published online Jan. 14 in the BMJ, pooled the results of seven previously completed studies on SSRI use during pregnancy and the risk of persistent pulmonary hypertension.
The analysis found that taking SSRIs during early pregnancy didn't lead to a significantly increased risk of the lung condition. But, when taken late in pregnancy, these medications were linked to a 2.5 times increase in the risk of persistent pulmonary hypertension.
That means that between 286 and 351 women would need to be treated with an SSRI in late pregnancy to result in an average of one additional case of persistent pulmonary hypertension, according to the study.
One difficulty for the researchers was pinning down the precise meaning of "late" pregnancy, as studies in the review had varying definitions. Late pregnancy could mean anytime during or after the 20th week, or it could mean during the third trimester, among other time frames.
Although the study found an increased risk of the lung problem, it wasn't designed to prove that the medications directly caused the problem. Grigoriadis said it's not clear exactly how SSRIs could cause persistent pulmonary hypertension.
She said that women shouldn't stop taking their medications, instead they should talk to their doctors if they have concerns.
"Decisions on treatment need to be personalized. Women need to make informed decisions by taking in all the risks of depression and its treatments. Psychosocial treatments [such as counseling] are appropriate for some women, depending on how severe the depression is, and how quickly [a woman] might respond to treatment," Grigoriadis said.
For her part, Frieder said, "It's good to see someone put all of these studies together in a uniform way. It makes me feel more comfortable about giving these medications. The risk is low, but it needs to be put into context with a woman's history. Treatment choices need to be individualized."
Read more about depression during pregnancy from the March of Dimes.
SOURCES: Sophie Grigoriadis, M.D., Ph.D., head, Women's Mood and Anxiety Clinic: Reproductive Transitions, Sunnybrook Health Sciences Center, Toronto; Ariela Frieder, M.D., psychiatrist, Montefiore Medical Center, New York City; Jan. 14, 2014, BMJ, online
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