1. Maternal Antidepressant Use and Risk of PPHN
Flavio Guzmán, MD

2. About PPHN Elevated pulmonary vascular resistance Birth
Vascular resistance drops
Birth
Elevated pulmonary vascular resistance
Nair, J., & Lakshminrusimha, S. (2014, March). Update on PPHN: mechanisms and treatment. InSeminars in perinatology (Vol. 38, No. 2, pp ). WB Saunders.

3. About PPHN Elevated pulmonary vascular resistance
Severe hypoxemia
Right-to-left shunting of blood through fetal circulatory pathways
Elevated pulmonary vascular resistance
Nair, J., & Lakshminrusimha, S. (2014, March). Update on PPHN: mechanisms and treatment. InSeminars in perinatology (Vol. 38, No. 2, pp ). WB Saunders.

4. Background

5. 2006
FDA: SSRIs late in pregnancy might increase the risk of PPHN
Study: sixfold increase in PPHN when mother took an SSRI
More studies:
2 positive
3 negative
2011
FDA: Uncertainty

6. 2006
FDA: SSRIs late in pregnancy might increase the risk of PPHN
Study: sixfold increase in PPHN when mother took an SSRI
More studies:
2 positive
3 negative
2011
FDA: Uncertainty

7. 2006
FDA: SSRIs late in pregnancy might increase the risk of PPHN
Study: sixfold increase in PPHN when mother took an SSRI
More studies:
2 positive
3 negative
2011
FDA: Uncertainty

8. Type: cohort study The Huybrechts study
Data from pregnant women and infants enrolled in Medicaid
Included a total of 3,789,330 women
Huybrechts, K. et al (2015). Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA, 313(21),

9. Type: cohort study The Huybrechts study 3.4 % used antidepressants
Huybrechts, K. et al (2015). Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA, 313(21),

10. Type: cohort study The Huybrechts study 2.7 % SSRIs
3.4 % used antidepressants
0.7 %
Non-SSRIs
Huybrechts, K. et al (2015). Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA, 313(21),

11. Incidence of PPHN Unexposed: 21/10,000 SSRIs: 32/10,000 Non-SSRIs:
29/10,000
Huybrechts, K. et al (2015). Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA, 313(21),

12. Odds Ratio
6.1
1.28
Huybrechts, K. et al (2015). Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA, 313(21),

13. Summary
There is a potential risk of PPHN associated with maternal use of SSRIs in late pregnancy
The overall risk might be more modest than previously described