Regarding use of antidepressants in pregnancy, which SSRI carries the highest risk of persistent pulmonary hypertension of the newborn (PPHN) when used in the third trimester?
- A Sertraline
- B Paroxetine
- C Escitalopram
- D Fluoxetine ✓
Explanation
Paroxetine is associated with a specific cardiovascular teratogenic concern (ventricular septal defects, particularly in the first trimester), but fluoxetine and paroxetine are the SSRIs most studied for PPHN risk in the third trimester. However, the association of SSRI use in late pregnancy with PPHN (relative risk approximately 2–3) applies class-wide. Among SSRIs, paroxetine has the most adverse reproductive data overall. Sertraline remains the preferred SSRI in pregnancy due to its relatively better safety profile. Note: untreated maternal depression itself poses significant risks; decisions require individualised risk-benefit analysis.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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