Antidepressant Use Late in Pregnancy and Risk of Persistent Pulmonary Hypertension of the Newborn.
This retrospective cohort study of publicly insured pregnant women found a potential increased risk of persistent pulmonary hypertension of the newborn (PPHN) associated with maternal use of SSRIs late in pregnancy. After restricting to women with depression, and adjusting for other confounders, relative risk was 1.10, and did not achieve statistical significance. This is more modest than suggested in previous studies.
- Cohort study of n=3,789,330 women, of which n=128,950 (3.4%) had used an antidepressant in the last 90 days of pregnancy. 79% of women using antidepressants used SSRIs.
- Data from 2000-2010 Medicaid Analytic eXtract for most US states.
- Exposure: filling at least one prescription for an antidepressant in last 90 days of pregnancy.
- Primary outcome: diagnosis of PPHN within 30 days of delivery.
- Analysis was limited to women with depression and stratified by propensity score to account for severity of depression and other potential confounders (e.g. age, race, multiple gestation, smoking status, sleep disorders, other medical or mental health conditions).
- Number of infants per 10,000 with PPHN, unadjusted (95% CI):
- 31.0 (28.1-34.2) for exposure to antidepressants in last 90 days of pregnancy.
- 20.8 (20.4-21.3) for no exposure to antidepressants.
- After restricting to depressed patients, and adjusting for high-dimensional propensity score, odds ratios were:
- 1.10 (95% CI, 0.94-1.29) for exposure to SSRIs.
- 1.02 (95% CI, 0.77-1.35) for exposure to non-SSRI antidepressants.
- Significant associations were observed between PPHN and several other factors (odds ratio, 95% CI):
- Maternal diabetes (2.93, 2.72-3.15)
- Cesarean delivery (3.20, 3.06-3.35)
- Black race (1.30, 1.24-1.36)
Huybrechts KF, Bateman BT, Palmsten K, et al. Antidepressant Use Late in Pregnancy and Risk of Persistent Pulmonary Hypertension of the Newborn. JAMA. 2015;313(21):2142-2151. doi:10.1001/jama.2015.5605.