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For the week ending February 10, 2012
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Last week 557 articles were evaluated via DynaMed's Systematic Literature Surveillance and 239 were added to DynaMed content.
Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.
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| Feature Article | |
SSRI Exposure During Later Pregnancy May Increase Risk of Persistent Pulmonary Hypertension of Newborn
Persistent pulmonary hypertension of newborn (PPHN) is a life threatening condition in which the infant fails to transition from high pulmonary vascular resistance and low pulmonary blood flow characteristic of fetal circulation to low pulmonary vascular resistance and high pulmonary blood flow of postnatal circulation. It occurs in 0.1%-0.2% of live births, with death in 10%-20% of cases (N Engl J Med 2006 Feb 9;354(6):579). To date, evidence for a link between maternal use of selective serotonin reuptake inhibitors (SSRIs) for depression and risk of PPHN has been inconsistent, and in December, 2011, the FDA recommended that health care providers not alter their current practice for treating depression during pregnancy (FDA MedWatch 2011 Dec 14). However, a new large retrospective cohort study published 1 month after the FDA statement strongly suggests that SSRI exposure does increase PPHN risk (level 2 [mid-level] evidence).
A total of 1,618,255 infants born > 33 weeks gestational age in 5 Nordic countries were evaluated for maternal use of any SSRIs. Mothers were stratified by date of SSRI exposure (at > 20 weeks gestational age, prior to pregnancy or before 8 weeks gestational age, or no exposure). PPHN developed in 0.29% of infants with later pregnancy exposure, 0.19% of infants with early pregnancy exposure, and 0.12% of infants with no exposure. Later exposure to any SSRI was associated with a significant increase in PPHN risk compared to no exposure (adjusted hazard ratio 2.1, 95% CI 1.5-3, NNH 416-1,666). Early exposure was associated with a trend toward increased risk. Results of subgroup analyses for individual SSRIs (sertraline, citalopram, paroxetine, and fluoxetine) were similar to the overall analysis (BMJ 2012 Jan 12;344:d8012). While there now appears to be a significantly increased risk, the condition is rare and the absolute risk remains low. These risks must be weighed against the benefits of treating the depression and compared to alternative options for the mother.
For more information, see the Persistent pulmonary hypertension of newborn, Medication and drug exposure in pregnancy, and Antidepressant use in pregnancy and lactation topics in DynaMed.
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CME Information
CREDITS
Physicians: 0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: February 15, 2012
Expiration Date: February 15, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.
To Receive Credit
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.
Program Overview
Learning Objectives
Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Faculty Information Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company
Disclosures
Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
No commercial support has been received for this activity.
Accreditation Statements
ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
AAFP: This activity, DynaMed Weekly Update 2011, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins March 2, 2011. Term of approval is for one year from this date. Each Weekly Update is approved for 0.25 Prescribed credits. Credit may be claimed for one year from the date of each Weekly Update. AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners. Program ID 1102071Y.
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