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
"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
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
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
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
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
"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.
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