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UCSD/Boston University Find Antidepressants May Affect Fetus
Newswire
2006-02-09
A University of California, San Diego (UCSD) School of Medicine collaborative study with Boston Universitys Slone Epidemiology Center found an increased risk of persistent pulmonary hypertension (PPHN) in newborns of mothers who used certain commonly prescribed antidepressants in late pregnancy. The results of the study will be published in the February 9 issue of the New England Journal of Medicine.
According to the study authors, PPHN is a serious condition that typically
involves severe respiratory failure in a newborn infant and requires immediate
treatment. The condition occurs in about one to two per thousand babies. The new
study findings indicate that pregnant women who take one of the antidepressants
known as selective serotonin reuptake inhibitors or SSRIs, such as Prozac,
Paxil or Zoloft, in the second half of pregnancy have a small but
significantly increased chance of delivering an infant who develops PPHN. The
study found that exposure to antidepressants other than SSRIs did not pose a
risk for PPHN. In addition, women who discontinued use of SSRIs in the first
half of pregnancy did not have an increased risk of delivering a child with the
condition.
These findings may be important for pregnant women and clinicians when making
decisions about the most appropriate treatments for depression late in
pregnancy.
Lead author on the study, Christina Chambers, Ph.D., M.P.H., of the
Departments of Pediatrics and Family and Preventive Medicine at UCSD, worked
with a team of investigators who identified at birth 377 infants with PPHN and
836 normal newborns from 97 delivery hospitals in four metropolitan centers in
the U.S. and Canada between 1998 and 2003. The study was part of the ongoing
Birth Defects Surveillance Program being conducted by the Slone Epidemiology
Center with the collaboration of 17 San Diego County hospitals including UCSD
Medical Center.
Within six months after birth, the researchers examined the records and
carefully interviewed the mothers of children with PPHN and the mothers of the
matched control infants selected from the same hospitals. The mothers in both
groups were asked specifically about the use of any antidepressant medications
during pregnancy, the names of products used, and the timing in gestation when
the mother used the medication. Mothers were also queried about a wide variety
of other maternal exposures, medical history, pregnancy history, and lifestyle
factors.
Based on our findings, we estimate that six to twelve mothers per thousand
who use an SSRI after 20 weeks gestation, are likely to deliver a child with
PPHN, said Chambers. Put in practical terms, the risk is relatively low --
about 99 percent of women exposed to one of these medications during the latter
half of pregnancy will deliver an infant unaffected by PPHN.
Our findings suggest that prenatal exposure to SSRIs might contribute to the
pathological origin of this disorder, says Chambers. She adds that although
the study cannot establish cause, several possible mechanisms suggesting an
association between the use of the SSRIs and PPHN are plausible.
Although the researchers noted an increased risk of PPHN in infants whose
mothers took SSRIs late in pregnancy, the research team points out that mothers
may need to continue SSRI treatment during pregnancy in order to care for
themselves appropriately. The findings of this study might be factored into
decisions about continuing treatment with SSRIs into late pregnancy.
The research team consisted of Chambers, Sonia Hernandez-Diaz, M.D. Dr.P.H of
Slone Epidemiology Center at Boston University School of Public Health, Linda J.
Van Marter, M.D., Ph.D of Boston Childrens Hospital, Brigham and Womens
Hospital, and Harvard Medical School, Martha M. Werler, Sc.D, and Allen A.
Mitchell, M.D. of Slone Epidemiology Center, and Kenneth Lyons Jones, M.D. of
the UCSD Department of Pediatrics.
Chambers is Program Director of the California Teratogen Information Service
(CTIS). CTIS operates a statewide telephone service and a clinical research
program from the Department of Pediatrics at UCSD with satellite offices at
UCLA, Los Angeles Childrens Hospital and Stanford University. Founded in
1979, this program provides no-cost, confidential information regarding the
fetal safety of medications, chemicals, or other agents when used in pregnancy.
The CTIS Pregnancy Risk Information line provides information to over 8,000
callers per year including pregnant or pre-pregnant women and health care
providers located throughout the state of California. The CTIS program also
conducts pregnancy outcome research studies so that evidence-based information
can be developed for women with similar questions in the future.
Pregnant women and health care providers can reach CTIS specialists by
calling toll free at 800-532-3749 or by contacting CTIS through their website at
http://www.ctispregnancy.org. For
people outside of California, information on exposures in pregnancy can be
obtained by calling the Organization of Teratology Information Specialists
(OTIS) national toll-free number 866-626-6847 or visiting the OTIS website at http://www.otispregnancy.org
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