The FDA is strongly considering revising the labels of all SSRI antidepressants based on recent New England Journal of Medicine article. The article links usage of antidepressants late in pregnancy with persistent pulmonary hypertension (PPHN), a condition that can endanger infants' lives.

Persistent pulmonary hypertension (PPHN) is also referred to as persistent fetal circulation. In this condition, a newborn baby's circulation changes back to the circulation of a fetus, where much of the blood flow bypasses the lungs. Generally, one to two newborns per 1,000 suffer from persistent pulmonary hypertension. These infants have pulmonary arterial pressure that is too high at birth. As a result, their lungs can't provide enough oxygen, which causes their bodies to produce oxygen-poor blood, sometimes resulting in death. In one study, nearly half the survivors were cognitively delayed, had major neurological problems, and could not hear.

When pregnant women took selective serotonin reuptake inhibitors after 20 weeks of conception, the risk of their infants developing persistent pulmonary hypertension rose sixfold, to about 1 in 100 newborns. The study size was too small to determine whether one antidepressant was riskier than another. Dr. James Mills of the National Institutes of Health commented in an editorial that this is the latest in a series of troubling reports of possible adverse effects of elective serotonin reuptake inhibitors (SSRIs) on developing fetuses.

The following are the most common symptoms of persistent pulmonary hypertension. However, each baby may experience symptoms differently. Symptoms may include:

• cyanosis (blue coloring)

• baby appears ill at delivery or in first hours after birth

• rapid breathing

• low blood oxygen levels while receiving 100 percent oxygen

• rapid heart rate

The FDA previously warned of a connection between Paxil, a popular antidepressant, and heart defects when the drug is taken early in pregnancies. The study described in the Journal article was observational and included interviews with 1,200 women within six months of giving birth.


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