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Persistent Pulmonary Hypertension of the Newborn (PPHN) is a rare—but potentially serious—respiratory and circulatory complication that can develop in a newborn. Newborns with PPHN, typically born at or near full-term, develop severe respiratory failure shortly after delivery. As estimated one to two infants per 1,000 born will develop this serious and life threatening condition. Even with proper medical treatment, ten to twenty percent of infants with PPHN will not survive.

A study published in the New England Journal of Medicine on February 9, 2006 showed that expectant mothers who used the SSRI antidepressant Prozac in the third trimester were over TWO times more likely to deliver a child with PPHN.

What is PPHN?

Before birth, the fetal circulatory system bypasses the lungs because the placenta supplies oxygen via the umbilical cord. During fetal development, the pulmonary artery sends blood from the heart directly back to the heart by way of the ductus arteriosus. When a child is born and the lungs begin to breathe in air, the pulmonary artery begins its new function of pumping blood from the heart to the lungs. The ductus arteriosus closes up permanently. Healthy newborns are able to adapt quickly to the outside world and breathing supplies all the oxygen the body needs.

In babies with PPHN, the circulatory system does not adapt quickly and the blood continues to bypass the lungs, depriving the lungs—and other vital organs and tissues—of necessary oxygen. Consequently, respiratory failure can ensue and all bodily systems become stressed due to lack of oxygen.

What are the causes of PPHN?

In most babies who develop PPHN, the exact cause of the condition is unknown. Medical evidence shows that fetal stress before birth may be a primary factor in the development of PPHN. Certain diseases and congenital conditions that affect the circulatory and/or respiratory systems may also increase the risk. Maternal risk factors —including diabetes, infection, use of NSAID drugs, and others—may also increase the risk of PPHN. There has been limited study into the causes of PPHN.

Now researchers are finding that maternal use of the antidepressant medication Prozac during the third trimester may drastically increase the risk of delivering a child with PPHN. Before conducting the study, researchers noted that infants born to mothers who used Prozac late in pregnancy were at an increased risk of developing respiratory problems, low blood pressure, jitteriness, signs of withdrawal, and other temporary complications. The Slone Epidemiology Center Birth Defects Study then set out to specifically determine the effects of third trimester Prozac exposure on newborns, with regards to PPHN.

After evaluating 377 cases of PPHN, 14 of the children whose mothers had taken Prozac during the third trimester developed PPHN, while only six children whose mothers did not take this SSRI developed PPHN. This means that third trimester Prozac use more than doubles the risk that a child will be born with PPHN. Researchers did not find an increased risk of PPHN in children delivered by mothers who used Prozac in the first or second trimesters.

Royal Prince Alfred Hospital - Persistent Pulmonary Hypertension Information

OBGYN Center Online - Antidepressant use while pregnant risky for baby

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