Persistent Pulmonary Hypertension Birth Defect


Persistent Pulmonary Hypertension of the Newborn (PPHN) is a rare condition where a lack of oxygen damages a baby's heart, lungs and brain, and can be fatal. This is one of the serious birth defects linked to antidepressant use during pregnancy.

Of the many serious birth defects linked to a pregnant woman’s use of antidepressants, persistent pulmonary hypertension of the newborn (PPHN) is among the most serious. This rare condition — which arises from a lack of oxygen — damages a baby’s heart, lungs and brain, and is fatal in 10 percent of cases.

One study reported women who take selective serotonin reuptake inhibitors (SSRIs) — a class of drugs that includes Prozac, Paxil and Zoloft —  during the last half of their pregnancies are six times more likely than others to have a child born with PPHN. One study also linked PPHN to antidepressant use in the first trimester. However, other studies estimate the risk is less than one percent.

If a newborn does develop PPHN and survives, he or she could be facing a lifetime of disabilities, including:

Many women who took an antidepressant during pregnancy and gave birth to a child with a birth defect are suing drug manufacturers, saying they were not sufficiently warned about the risks.

Persistent Pulmonary Hypertension Linked to Antidepressant Use

Pregnant women with depression are often prescribed an antidepressant because they are considered the best standard of treatment. After following her doctor’s advice and taking an antidepressant, however, a woman may give birth to a seriously ill baby.

In a baby born with PPHN, the circulatory system doesn’t switch over to breathing air. Instead, the blood flow continues to bypass the lungs, depriving the vital organs of oxygen.

Parents are likely to notice these common symptoms of PPHN:
Quick breathing (tachypnea) Rapid heart rate (tachycardia)
Breathlessness Blue tint to skin (cyanosis)
Sluggish behavior (lethargy) Sweating
If a baby has at least one PPHN symptom, a doctor may order imaging and blood tests to confirm the diagnosis of PPHN. Doctors also will look for these additional symptoms:
Heart murmur Insufficient oxygenation of the blood
Low blood pressure (hypotension) Weak pulse
Swelling in the hands or feet (edema) Enlarged liver (hepatomegaly)

To rule out other conditions, your baby's doctor likely will order chest X-rays, an ultrasound of the head, electrocardiography and blood tests.

The goal in treating a newborn diagnosed with PPHN is to increase the amount of oxygen flowing into the lungs, and consequently, the level in the blood. This can be accomplished by using a breathing mask, plastic hood or ventilator; the baby may also be given nitric oxide, which can relax the blood vessels in the lungs and increase the blood flow.

When a baby does not respond to the first line of treatment, High Frequency Oscillatory Ventilation (HFOV) and Extracorporeal Membrane Oxygenation (ECMO) can be employed. ECMO requires surgery and is a modified heart-lung bypass technique.

FDA Warnings on PPHN Risk

The Food and Drug Administration (FDA) issued a Public Health Advisory on July 19, 2006, warning of the potential risk of PPHN in babies of mothers who took antidepressants during pregnancy. The advisory was based on a single study. The agency asked the manufacturers of all SSRIs to change prescribing information to describe the potential risk for PPHN.

On Dec. 14, 2011, the FDA issued a follow-up Safety Communication, stating that subsequent studies had clouded the PPHN issue and that health care professionals should not alter their current clinical practice of treating depression during pregnancy. The agency also requested that health care professionals report any adverse events involving antidepressants.

A 2014 study published in the British Medical Journal found more evidence that SSRIs taken during pregnancy increase the risk of PPHN. Specifically, researchers found that babies exposed to this class of antidepressants during the late stages of pregnancy were at increased risk of PPHN.

The authors of the study state that pregnant women should be educated about the risks of PPHN, should know what the symptoms are and what treatments are available for it at the hospital where the birth will take place.