Pregnancy should not rule out SSRIs

GPs have been advised not to rule out the use of SSRIs in pregnant women, despite a study showing that they increase the risk of persistent pulmonary hypertension (PPHN) and another associating them withdrawal symptoms in the newborn.

Researchers at the University of California, San Diego (UCSD) School of Medicine in the US, identified a small but significant increased risk of PPHN in the newborns of mothers who took SSRIs in late pregnancy.

There was no increased risk in the babies of women who took other antidepressants or who discontinued SSRIs in the first half of pregnancy.

The researchers examined the records of 377 infants with PPHN and 836 normal newborns, and interviewed the mothers about their lifestyle and antidepressant use.

The risk of delivering a child with PPHN if the mother took SSRIs after 20 weeks' gestation was found to be six-12 in 1,000.

Another study, conducted in Israel, showed that one in three babies born to women who took SSRIs for prolonged periods during pregnancy experienced neonatal abstinence syndrome, a type of withdrawal with symptoms that include high-pitched crying, tremors and disturbed sleep.

The researchers studied 120 babies born between January 2001 and August 2004. Half of the mothers had taken SSRIs for prolonged periods of time, and 18 of their babies had neonatal abstinence syndrome.

Dr Jim Kennedy, RCGP prescribing spokesman, said prescribing any drug in pregnancy was always a difficult issue and GPs should continue to question the need. Non-drug treatments, such as cognitive behavioural therapy, should obviously be considered as supplements or alternatives to drugs, he said.

But he added: 'Pregnancy is not an absolute contraindication. You have to weigh up the benefit and the risk for each individual woman.

'For some women the depression is so severe that the risk for them and their loved ones is significantly higher if they do not take the antidepressants.'

He warned that it was important to treat depression promptly in pregnancy because it could worsen rapidly.

NICE is due to issue a draft guideline on antenatal and postnatal mental health in the summer and a final guideline next year.

N Engl J Med 2006; 354: 579-87, 636-8

Arch Pediatr Adolesc Med 2006; 160: 173-6

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Risk of SSRI use in pregnancy:

- SSRI use in late pregnancy associated with 1 per cent risk of persistent pulmonary hypertension in the baby.

- Prolonged SSRI use in pregnancy linked to neonatal abstinence syndrome in one in three newborns.

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