Persistent pulmonary hypertension o...

Persistent pulmonary hypertension of the newborn (PPHN) is a rare yet often fatal condition in which the fetal circulation persists after birth, leading to hypoxemia and respiratory failure. be deriveds of a previous cohort research suggested a possible link between PPHN and maternal selective serotonin reuptake inhibitor (SSRI) use in late pregnancy. Chambers and colleagues deportment ed a case-control study involving women whose infants lay opened PPHN to determine whether SSRI use after 20 weeks' gestation was associated with a higher risk of this condition.

Potential participants were identified from medical record reviews, telephone calls, and referrals at 97 institutions in Boston, Mass.; Philadelphia, Penn; San Diego, Calif.; and Toronto, Canada. Criteria for PPHN were (1) accurate respiratory failure shortly after birth at greater than 34 weeks' gestation, and (2) evidence of pulmonary hypertension in succession echocardiography or a difference of more than 5 percent between preductal and postductal oxygen saturation. The rule group consisted of mothers who delivered healthy newborns at the same hospitals; reign over participants were matched to patients by means of delivery dates in a 2:1 ratio.

About seven disclosed of 10 mothers in each form into groups who were invited to participate in the consideration agreed, making a total of 377 cogitation participants and 836 matched restrain participants. Mothers who delivered infants with PPHN were more likely than those in the direction group to be black (adjusted left over s ratio [OR], 2.3; 95% confidence interval [CI], 14 to 38) or Asian (adjusted OR, 22; 95% CI, 12 to 39) and to have had a prepregnancy corpse mass index greater than 27 kg for [m.sup.2] (adjusted OR, 2.6; 95% CI, 16 to 40)

All mothers were interviewed from one side of to the other the telephone within six month after delivery. The interviews were guidanceed by trained nurses who did not know the subject of attention hypothesis and included elicitation of a medication history with specific questions about antidepressant use during pregnancy. To aid recall of medication use, calendars were provided highlighting the dates of the last menstrual period and delivery. Late pregnancy front to SSRIs was defined as any use that occurr more than 20 calendar weeks after the first day of the last menstrual period.

Fourteen mothers who delivered infants with PPHN and six superintendence mothers reported using SSRIs after 20 weeks' gestation. When adjustments were made for potential confounder multivariate regression analysis demonstrated that mothers who reported using SSRIs in late pregnancy were approximately six times more likely to deliver infants with PPHN than mothers who reported no like use (adjusted OR, 6.1; 95% CI, 22 to 168) In contrast, no increased risk for PPHN was lay the foundation of with maternal SSRI use before 20 weeks' gestation or with use of other classes of antidepressants at any time during pregnancy. The be deriveds did not change significantly when the analysis was restricted to infants born at 37 weeks' gestation or later.

The authors deduce that maternal SSRI use after 20 weeks' gestation is associated with a significantly increased risk of delivering an infant with PPHN They speculate that higher circulating serotonin flats may predispose newborns to PPHN from stimulating smooth-muscle cell proliferation in the fetal lung and inhibiting nitric oxide synthesis.

Ten to 15 percent of women of reproductive age unfold a major depressive disorder. Because the absolute increase in risk for PPHN observ in this reflection was small (i.e., six to 12 cases through 1,000 births), the authors commend that physicians incorporate these findings into discussions about the benefits and risks of antidepressant treatment with patients who are pregnant.

KENNETH W LIN, MD

Chambers CD et al. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J M February 9 2006;354:579-87

EDITOR'S NOTE: Decisions about the use of antidepressant medication ideally should be made before conception. In practice, however, many women continue taking SSRIs for weeks before finding that they are pregnant. This research showed that, regarding the risk of PPHN the decision of whether to continue SSRI therapy may safely be delayed until 20 weeks' gestation. At that point, physicians and patients must weigh potential risks to the developing fetus against the risk of returning depression. Results from a prospective consideration (1) involving 201 women who were pregnant and had a history of major depressive disorder showed that those who discontinued antidepressants during pregnancy were five times more likely to experience a relapse than those who continued to take their medication. Although there may not be a completely safe choice regarding SSRI use in pregnancy, physicians should make certain that this choice is an informed one--KWL

REFERENCE

(1) Cohen L Altschuler LL Harlow BL Nonacs R Newport DJ Viguera AC, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA 2006;295:499-507

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