SSRIs and persistent pulmonary hypertension of the newborn

Persistent pulmonary hypertension in the newborn is a life threatening neonatal syndrome characterised by failure of reversal at birth of the high vascular resistance seen in the fetal pulmonary circulation.1 The syndrome occurs in 1-2 per 1000 live births, typically in full term babies. The resulting ineffective oxygenation and respiratory failure necessitate respiratory support and drug treatment in an attempt to induce vasodilation of the pulmonary vessels. A cause can be established in some cases, and meconium aspiration, perinatal asphyxia, sepsis, and cardiac malformations are the leading known causes.2 Different series have reported a mortality of 5-10%.1

In 2006 a case-control study found that significantly more mothers of babies with this syndrome than mothers of healthy neonates had reportedly used selective serotonin reuptake inhibitors (SSRIs) in late pregnancy.3 Subsequent studies assessing this association have produced conflicting results.4 5 6 7

In the linked cohort study (doi:10.1136/bmj.d8012), Kieler and colleagues collected data from more than 1.6 million mother-infant pairs. They found that exposure to SSRIs after 20 weeks’ gestation was associated …