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Selective serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: population based cohort study from the five Nordic countries

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.d8012 (Published 12 January 2012) Cite this as: BMJ 2012;344:d8012

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Re: Selective serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: population based cohort study from the five Nordic countries

Selective Serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: population based cohort study from five Nordic countries

This study1 addresses a very important issue in view of the potential impact on antidepressant prescribing habits in pregnancy, and women’s willingness to take SSRIs.
A limitation acknowledged by the authors is the difficulty in accurately measuring exposure to SSRIs. We agree with Petersen and colleagues 4 that dispensing does not equate to usage or exposure. The paper quotes studies 2 3 suggesting at best a 70% reported compliance rate with antidepressants in pregnancy, which might affect the results and possibly the overall associations. It is theoretically possible to have unknown factors which could predispose to developing Persistent Pulmonary Hypertension and are also associated with the compliance of pregnant women with medication.
Persistent pulmonary hypertension has a significant health impact on infants, but so does depression in pregnancy. We await further studies which address an even wider range of possible confounders, and clarify the strength and importance of this association.

References
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1.Kieler H, Artama M, Engeland A, Ericsson Ö, K Furu, Gissler M, et al
Selective Serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: population based cohort study from five Nordic countries. BMJ2011;344:d8012.
2.Olsen C, Søndergaard C, Thrane N, Nielsen G,L, de Jong-van den Berg L et al Do Pregnant Women Report Use Of Dispensed Medications?. Epidemiology September 2001, Vol. 12 No 5.
3.Stephansson O, Granath F, Svensson T, Haglund B, Ekbom A, Kieler H
Drug use during pregnancy in Sweden- assessed by the prescribed Drug Register and the Medical Birth Register. Clinical Epidemiology 2011:3 43-50.
4.Petersen I, Nazareth I,Gilbert R, Freemantle N. E-response to the article written by Kieler and colleagues.

Competing interests: No competing interests

16 March 2012
Akintunde O Alabi
Psychiatric Registrar
Joe Reilly
Durham University Centre for Integrated Health Care Research Wolfson Research Institute
Durham University Centre for Integrated Health Care Research Wolfson Research Institute Queen's Campus University Boulevard Thornaby Stockton on Tees