Prenatal exposure to antidepressants and persistent pulmonary hypertension of the newborn: systematic review and meta-analysis

Objective To examine the risk for persistent pulmonary hypertension of the newborn associated with antenatal exposure to antidepressants.Design Systematic review and meta-analysis.Data sources Embase, Medline, PsycINFO, and CINAHL from inception to 30 December 2012.Eligibility English language studi...

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Bibliographic Details
Published in:BMJ (Online) 2014-01, Vol.348 (7941), p.f6932-13
Main Authors: Grigoriadis, Sophie, VonderPorten, Emily H, Mamisashvili, Lana, Tomlinson, George, Dennis, Cindy-Lee, Koren, Gideon, Steiner, Meir, Mousmanis, Patricia, Cheung, Amy, Ross, Lori E
Format: Article
Language:English
Subjects:
Abnormalities, Drug-Induced
Antenatal
Antidepressant drugs
Antidepressants
Antidepressive Agents - adverse effects
Antidepressive Agents - therapeutic use
Anxiety
Body mass
Body mass index
Congenital defects
Congenital diseases
Data processing
Depression - drug therapy
Epidemiology
Evidence-based medicine
Feces
Female
Global Health
Humans
Hypertension
Hypertension, Pulmonary - chemically induced
Hypertension, Pulmonary - epidemiology
Incidence
Infant, Newborn
Infant, Newborn, Diseases - chemically induced
Infant, Newborn, Diseases - epidemiology
Infants
Keywords
Meconium
Meta-analysis
Newborn babies
Nitric oxide
Observational studies
Pregnancy
Pregnancy Complications - drug therapy
Pregnant women
Premature Birth
Prenatal care
Prenatal experience
Prenatal exposure
Prenatal Exposure Delayed Effects
Psychotropic drugs
Pulmonary hypertension
Respiratory therapy
Reviews
Risk exposure
Risk Factors
Serotonin reuptake inhibitors
Serotonin uptake inhibitors
Serotonin Uptake Inhibitors - adverse effects
Serotonin Uptake Inhibitors - therapeutic use
Statistical analysis
Systematic review
Womens health
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Summary:Objective To examine the risk for persistent pulmonary hypertension of the newborn associated with antenatal exposure to antidepressants.Design Systematic review and meta-analysis.Data sources Embase, Medline, PsycINFO, and CINAHL from inception to 30 December 2012.Eligibility English language studies reporting persistent pulmonary hypertension of the newborn associated with exposure to antidepressants. Two independent reviewers extracted data and assessed the quality of each article.Results Of the 3077 abstracts reviewed, 738 papers were retrieved and seven included. All seven studies were above our quality threshold. Quantitative analysis was only possible for selective serotonin reuptake inhibitors (SSRIs). Although exposure to SSRIs in early pregnancy was not associated with persistent pulmonary hypertension of the newborn (odds ratio 1.23, 95% confidence interval 0.58 to 2.60; P=0.58), exposure in late pregnancy was (2.50, 1.32 to 4.73; P=0.005). Effects were not significant for any of the moderator variables examined, including study design, congenital malformations, and meconium aspiration. It was not possible to assess for the effect of caesarean section, body mass index, or preterm delivery. The absolute risk difference for development of persistent pulmonary hypertension of the newborn after exposure to SSRIs in late pregnancy was 2.9 to 3.5 per 1000 infants; therefore an estimated 286 to 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 of the newborn.Conclusions The risk of persistent pulmonary hypertension of the newborn seems to be increased for infants exposed to SSRIs in late pregnancy, independent of the potential moderator variables examined. A significant relation for exposure to SSRIs in early pregnancy was not evident. Although the statistical association was significant, clinically the absolute risk of persistent pulmonary hypertension of the newborn remained low even in the context of late exposure to SSRIs.
ISSN:0959-8138
1756-1833
0959-8146
1756-1833
DOI:10.1136/bmj.f6932