Antidepressant Use Late in Pregnancy May Increase Risk of PPHN Birth Defect

Birth Injuries

By Nathan Williams, Staff Writer

PPHN, short for Persistent Pulmonary Hypertension of the Newborn, can be defined as “…the failure of the normal circulatory transition that occurs after birth.” It occurs in approximately 2 per 1,000 live births in the U.S. and is fatal in about 10% of cases.

More specifically, the baby’s respiratory and circulatory system reverts back to what it was in the womb, which is why this specific birth defect or injury is referred to as “persistent fetal circulation.” Since the baby’s lungs are not needed during the pregnancy, blood is moved away through special connections with the heart.

If an infant has PPHN, blood will not flow to the lungs so the newborn can breathe normally. Lack of oxygen can cause serious, sometimes permanent damage to a baby’s heart, lungs and brain.

If a baby has PPHN, she will look ill at birth and in her first few hours of life and have a blue coloring in her face. She will experience rapid breathing and heart rate and will also have low blood oxygen levels despite receiving 100% oxygen through a machine.

Treatment for this condition depends on the individual, but generally speaking, doctors will place the baby on supplemental oxygen through a machine (face mask) or endotracheal tube into the baby’s windpipe. Certain medications will be used to relax the muscles so the child can fully benefit from the supplemental oxygen.

Basically speaking, the main goal of this treatment is to get the baby to breathe normally on her own, but in extreme cases, the baby may need a lung transplant.

Although rare, one study shows that using Selective Serotonin Reuptake Inhibitors (SSRIs) during the last half of pregnancy increases the risk of PPHN by a factor of 6

SSRIs are the most common type of medications prescribed to treat depression. Well-known brand names include Prozac, Paxil and Zoloft. Medications like this work by blocking the reabsorption, or reuptake, of serotonin in the brain, which helps cells better send and receive chemical messages and improves the patient’s mood.

While SSRIs don’t typically cause disastrous side effects during ordinary times, it can increase the risk of PPHN significantly if taken after week 20 of the pregnancy according to a study published in the New England Journal of Medicine in 2006. Following the release of this study, the FDA issued a notice warning doctors and pregnant women of the risk of taking SSRIs during pregnancy.

An additional study from 2014 published in the British Medical Journal substantiates findings in the previous study.

However, other research studies did not clearly demonstrate a link between SSRI use and PPHN, with one pegging the risk at less than 1%. This led the FDA to issue a follow-up advisory stating that physicians shouldn’t alter their standard approach to treating depression, but they should also keep a close eye on any pregnant patients and report any adverse side effects.  

Also, exactly how medications like Prozac, Paxil and Zoloft causes PPHN is still unknown.

To date, there haven’t been a large number of lawsuits brought against Prozac manufacturer Eli Lilly for any possible connection to the PPHN birth defect. Most Prozac litigation dates back to the 1990s involving claims of suicidal thoughts and violent behavior.

However, cases involving Zoloft and birth defects like craniosynostosis, heart defects and PPHN were consolidated into a multidistrict litigation (MDL) in April 2012 in the U.S. District Court for Eastern Pennsylvania.

The key to any potential litigation involving Prozac or any other SSRI and PPHN will be whether the company in question knew of any risks to newborn children. If it can be proven the company withheld vital information from patients, they could be held liable for any injuries.

We invite you to learn more by visiting our birth injury information page, and if you believe your child was injured at birth due to Prozac or another SSRI medication, search our directory today to find an attorney who can evaluate your case.


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