Preterm Birth and Antidepressant Medication Use during Pregnancy: A Systematic Review and Meta-Analysis

Huybrechts, Krista F.; Sanghani, Reesha S; Avorn, Jerry; Urato, Adam C.

doi:10.1371/journal.pone.0092778

Cited by 111 publications

(96 citation statements)

References 88 publications

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“…Clinicians and patients need to balance the potential small increase in the risk of PPHN, along with other risks that have been attributed to SSRI use during pregnancy, 37,38 with the benefits attributable to these drugs in improving maternal health and well-being. 39…”

Section: Discussionmentioning

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

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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 ...

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Section: Discussionmentioning

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

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“…30,[41][42][43][44] Meta-analyses and other reports consistently suggest an increase of approximately 1.5-2 fold in the risk for preterm birth (PTB) in women using SSRIs compared to the controls. 26,46,47,[58][59][60] It has been reported that high doses (e.g., more than 40 mg/day for fluoxetine, citalopram, and paroxetine), 61,62 longer exposure, 42,63 and usage during the 2nd and 3rd trimesters 47 seem to be connected with a greater risk of preterm birth. Clinical studies have shown a lack of clear evidence of a negative influence on neurocognitive development with antidepressant usage.…”

Section: Congenital Malformationsmentioning

confidence: 99%

“…48,49,64 Data are also conflicting regarding the relationship between antenatal antidepressant exposure and other neonatal outcomes such as spontaneous abortion, birth weight, persistent pulmonary hypertension, and autism spectrum disorders. 23,26,35,47,[50][51][52][53][54][55][56][57]60,[65][66][67][68][69] Specific information on the risk of other neonatal outcomes in fetuses exposed to clomipramine is lacking. The limited available data suggest that similar to SSRIs, TCAs may be associated with PTB and PNAS.…”

Section: Congenital Malformationsmentioning

confidence: 99%

Pharmacotherapy of obsessive-compulsive disorder during pregnancy: a clinical approach

Uğuz

2015

Rev. Bras. Psiquiatr.

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Obsessive-compulsive disorder (OCD) is a relatively common psychiatric disorder in the perinatal period. However, specific pharmacological treatment approaches for patients with OCD during pregnancy have not been satisfactorily discussed in the literature. In addition, there are no randomized controlled studies on the treatment of this disorder during pregnancy. The present paper discusses the pharmacological treatment of OCD in the light of data on the safety of antipsychotics and serotonergic antidepressants during pregnancy and their efficacy in the non-perinatal period. Treatment decisions should be individualized because the risk-benefit profile of pharmacotherapy is an important issue in the treatment of pregnant women with any psychiatric diagnosis.

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“…However, it is diffi cult to tease out the infl uence of depression when factors such as drugs, alcohol, and smoking are frequently associated with depression [ 31 -33 ]. The use of antidepressant medication during pregnancy is now commonplace and has been associated with an increased risk of preterm birth [ 34 ]. The underlying mechanism of how depression results in preterm birth is unclear, but there is growing evidence to suggest that stress and infl ammatory markers (C-reactive protein, IL-6, IL-1β, and TNF-α are elevated in depression, and this may relate to the increased risk of preterm birth [ 35 ].…”

Section: Maternal Risk Factors For Spontaneous Preterm Labor and Pprommentioning

confidence: 99%

Prematurity

Kent¹

2015

Keeling’s Fetal and Neonatal Pathology

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Preterm birth is defi ned as delivery less than 37 weeks' gestational age. The rate of preterm birth varies around the world and differs between developed and developing countries. It is 12-13 % in the United States of America (USA), 5-9 % in Europe, 9 % in Australia, and as high as 18 % in some countries in Africa. In developed countries the increased rate of preterm birth has been attributed to the changing demographics of childbearing. The mean age of childbearing has increased over the years with the average age of primiparous women in Australia now 28.3 years of age and the percentage of fi rst-time mothers over 35 years of age in the USA now 4 %. Delayed childbearing is associated with a number of risk factors including preeclampsia and gestational diabetes. Infertility with the resultant use of in vitro fertilization methods and consequent twins/triplets are also signifi cant issues. Another major risk factor for preterm birth is maternal obesity, which is increasing in both developed and developing countries. Complications of maternal obesity include maternal and fetal death, preeclampsia, gestational diabetes, and congenital abnormalities. Preterm BirthPreterm birth is defi ned as delivery less than 37 weeks' gestational age. The rate of preterm birth varies around the world and differs between developed and developing countries. It is 12-13 % in the USA, 5-9 % in Europe, 9 % in Australia, and as high as 18 % in some countries in Africa [ 1 -3 ]. In 2010 more than 60 % of preterm births occurred in south Asia and sub-Saharan Africa [ 2 ]. In developed countries the increased rate of preterm birth has been attributed to the changing demographics of childbearing. The mean age of childbearing has increased over the years with the average age of primiparous women in Australia now 28.3 years of age [ 3 ] and the percentage of fi rsttime mothers over 35 years of age in the USA now 4 % [ 4 ]. Delayed childbearing is associated with a number of risk factors including preeclampsia and gestational diabetes. Infertility

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Preterm Birth and Antidepressant Medication Use during Pregnancy: A Systematic Review and Meta-Analysis

Cited by 111 publications

References 88 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

Pharmacotherapy of obsessive-compulsive disorder during pregnancy: a clinical approach

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