Antidepressant Use in Pregnancy and the Risk for Cardiac Defects

Huybrechts, Krista F.; Palmsten, Kristin; Avorn, Jerry; Cohen, Lee S.; Holmes, Lewis B.; Franklin, Jessica M.; Mogun, Helen; Levin, Raisa; Kowal, Mary K.; Setoguchi, Soko; Hernández–Dı́az, Sonia

doi:10.1097/01.ogx.0000456348.32099.6d

Cited by 25 publications

(51 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We created 100 propensity score strata of equal width, removed strata that did not contain at least 1 treated woman and 1 untreated woman because they are uninformative, and stratified the outcome models by these propensity score strata. 25 The high-dimensional propensity score algorithm evaluates thousands of inpatient and outpatient diagnoses, procedures, and pharmacy claims and prioritizes those covariates that may act as proxies for unmeasured confounders. These empirically identified confounders (n = 200) were combined with the investigator-specified covariates listed above in a propensity score model to improve confounding adjustment.…”

Section: Author Manuscript Author Manuscriptmentioning

confidence: 99%

Antidepressant Use Late in Pregnancy and Risk of Persistent Pulmonary Hypertension of the Newborn

Huybrechts

Bateman

Palmsten

et al. 2015

Obstetrical &Amp; Gynecological Survey

Self Cite

View full text Add to dashboard Cite

IMPORTANCE-The association between selective serotonin reuptake inhibitor (SSRI) antidepressant use during pregnancy and risk of persistent pulmonary hypertension of the newborn (PPHN) has been controversial since the US Food and Drug Administration issued a public health advisory in 2006. PARTICIPANTS-A total of 3 789 330 pregnant women enrolled in Medicaid from 2 months or fewer after the date of last menstrual period through at least 1 month after delivery. The source cohort was restricted to women with a depression diagnosis and logistic regression analysis with propensity score adjustment applied to control for potential confounders. CONCLUSIONS AND RELEVANCE-Evidence from this large study of publicly insured pregnant women may be consistent with a potential increased risk of PPHN associated with maternal use of SSRIs in late pregnancy. However, the absolute risk was small, and the risk increase appears more modest than suggested in previous studies. OBJECTIVE-To HHS Public AccessThe high pulmonary vascular resistance characteristic of fetal circulation fails to decrease at birth in 10 to 20 newborns in every 10 000 live births, resulting in right-to-left shunting of blood through fetal channels, diminished pulmonary blood flow, and profound hypoxemia. 1,2 Such persistent pulmonary hypertension of the newborn (PPHN) typically occurs in term or near-term infants and presents within hours of birth with severe respiratory failure requiring intubation and mechanical ventilation. 2 Persistent pulmonary hypertension of the newborn is associated with substantial morbidity and mortality: 10% to 20% of affected infants will not survive, and infants who survive face serious long-term sequelae including chronic lung disease, seizures, and neurodevelopmental problems due to both the hypoxemia and the aggressive treatments it often requires. 1,[3][4][5][6] In 2006, the US Food and Drug Administration (FDA) issued a public health advisory on a potential increased risk of PPHN associated with late pregnancy exposure to selective serotonin reuptake inhibitors (SSRIs) based on a single epidemiologic study that found a 6-fold increase in risk associated with SSRI use after the 20thweek of pregnancy. 7,8 Based on a review of additional studies with conflicting findings (2 studies reported an increase in risk, whereas 3 did not), the FDA concluded in 2011 that it was premature to reach any conclusion about a possible link between SSRI use in pregnancy and PPHN and updated the advisory accordingly. [9][10][11][12][13] The negative studies tended to be small, raising the possibility that they had insufficient power to detect an increased risk. 10,11 Given the ongoing controversy regarding the association between SSRI exposure in late pregnancy and the risk of this highly morbid pregnancy outcome, we examined the risk of The approach used for the development of our study cohort has previously been described in detail. 14 We identified all completed pregnancies in women aged 12 to 55 years and linked these pregnancies to ...

show abstract

Section: Author Manuscript Author Manuscriptmentioning

confidence: 99%

Antidepressant Use Late in Pregnancy and Risk of Persistent Pulmonary Hypertension of the Newborn

Huybrechts

Bateman

Palmsten

et al. 2015

Obstetrical &Amp; Gynecological Survey

Self Cite

View full text Add to dashboard Cite

show abstract

“…In 2005, the Food and Drug Administration made an advisory warning stating that there was an increased risk of cardiac malformations with the use of paroxetine (13). This was found for doses >25 mg daily (13), and there was no evidence for other SSRIs (14). Another concern is the potential for negative developmental effects in the offspring.…”

Section: Risks Of Ssrismentioning

confidence: 99%

Choosing and Discussing SSRIs for Depression in Pregnancy: A Basic Guide for Residents

Gorun

2018

AJP Residents' Journal

View full text Add to dashboard Cite

“…20 At the same time, sertraline, while not reclassified, had also been associated with an increased risk for ventricular septal defects. 20 A follow-up nationwide cohort study of 949,504 pregnant Medicaid recipients from 2000 to 2007 showed a relative risk of any cardiac defect of 1.25 (95% confidence interval [CI], 1.13-1.38) in an unadjusted analysis of women using an SSRI in the first trimester. However, when adjusted for patients with only a depression diagnosis to control for confounding comorbid conditions, the relative risk was 1.12 (95% CI, 1.00-1.26).…”

Section: Antidepressantsmentioning

confidence: 99%

“…18,20,21 United States prevalence rates of SSRI use in pregnancy range from 8% to 13%. 8,20 Since up to 50% of pregnancies are unplanned, it is important for patients and health-care providers to be familiar with the impact of fetal exposure to SSRIs when prescribing these medications to women of reproductive age. While SSRIs are the mainstay of therapy and generally considered to be safe for use in pregnancy, there are some risks that must be considered.…”

Section: Antidepressantsmentioning

confidence: 99%

“…Contrary to previous evidence, they found no significantly increased risk for paroxetine and right ventricular outflow tract obstruction and for ventricular septal defects with sertraline. 20 A Danish cohort study examining 72,280 pregnancies using the EUROCAT register (database of congenital anomalies) from 1995 to 2008 showed an increased risk of severe congenital heart defects (CHD) with first-trimester SSRI exposure. Twelve percent of pregnant women filled an SSRI prescription in the first trimester, with citalopram being the most commonly redeemed (35.4%).…”

Section: Antidepressantsmentioning

confidence: 99%

See 1 more Smart Citation

Psychotropic Medications in Pregnancy and the Postpartum Period

Haas

McHugh

Durst

et al. 2015

Clinical Medicine Insights: Therapeutics

View full text Add to dashboard Cite

Many pregnant women suffer from mental health conditions while pregnant. As providers and patients make decisions about risks of the conditions and treatments during pregnancy, information to populate those discussions is needed. Taking into account the physiologic changes in pregnancy, we may need to optimize medication therapy. This article reviews and summarizes some of the most common mental health conditions suffered in pregnancy: depression, bipolar disorder, anxiety, and psychosis. It further discusses the different medications used to treat them, as well as risks associated with these medications.

show abstract

Antidepressant Use in Pregnancy and the Risk for Cardiac Defects

Cited by 25 publications

References 21 publications

Antidepressant Use Late in Pregnancy and Risk of Persistent Pulmonary Hypertension of the Newborn

Antidepressant Use Late in Pregnancy and Risk of Persistent Pulmonary Hypertension of the Newborn

Choosing and Discussing SSRIs for Depression in Pregnancy: A Basic Guide for Residents

Psychotropic Medications in Pregnancy and the Postpartum Period

Contact Info

Product

Resources

About