New concerns on SSRIs
The UK's drug regulator is considering new evidence that could widen warnings over the use of SSRIs in pregnancy.
A study published last week in the New England Journal of Medicine, and first reported by Pulse last September, concludes maternal use of a range of SSRIs may raise the risk of persistent pulmonary hypertension of the newborn.
It follows a bulletin from the Medicines and Healthcare Products Regulatory Agency in December urging caution in use of paroxetine in pregnancy.
Study leader Dr Christine Chambers, professor of paediatrics and family and preventive medicine at the University of California in San Diego, said: 'These findings are important for both patients and physicians in choosing the best course of action.'
Dr Chambers and her colleagues studied 377 mothers whose infants developed the condition and found 14 had taken SSRIs after the 20th week of pregnancy. This compared with just six from 836 controls and represented a six-fold increase in risk.
'This study adds to the body of knowledge, but cannot say definitively that SSRI use late in pregnancy causes PPHN,' she cautioned.
The MHRA said: 'This study suggests the occurrence of primary pulmonary hypertension in newborns may be associated with the use of SSRIs by the mother in the later stages of her pregnancy.
'The MHRA in conjunction with European regulatory authorities is carefully considering all available data and will seek expert advice from the Commission on Human Medicines. New advice will be issued as necessary.'
GPs said the new evidence highlighted the need to seek specialist advice.
Dr Simon Lockett, a GP in Norwich and former prescribing lead, said: 'GPs hopefully never prescribe anything in pregnancy unless it's absolutely necessary.
'If someone is going to get an antidepressant and it's getting more and more difficult to know what is safe, the consequence will be more referrals to specialists.'
Dr David Russell, Darlington PCT prescribing lead, said: 'What GPs should be doing is taking advice from secondary care. I don't think we should deal with it on our own.'
A second study, in Archives of Pediatrics and Adolescent Medicine, found nearly a third of babies born to mothers on SSRIs exhibited withdrawal symptoms.