Which specific SSRI has a category D/X pregnancy warning due to risks associated with pulmonary hypertension in newborns?

Paroxetine is the selective serotonin reuptake inhibitor (SSRI) that carries a category D/X pregnancy warning primarily due to its association with an increased risk of pulmonary hypertension in newborns when taken during pregnancy. This risk has been observed particularly in the later stages of pregnancy and is a significant concern for healthcare providers when prescribing medications to pregnant individuals.

The categorization of paroxetine as category D means that there is evidence of risk to the fetus based on human data, but potential benefits may warrant use in pregnant women despite these risks in certain situations. This potent warning arises from several studies that have demonstrated an association between paroxetine use in pregnancy and the development of persistent pulmonary hypertension of the newborn (PPHN), a serious condition that can lead to significant morbidity.

In contrast, other SSRIs such as sertraline, citalopram, and fluvoxamine do not have the same level of documented association with this particular risk in newborns, making paroxetine distinct in its classification and warning. This differentiation is crucial for clinicians and patients when considering the safety of antidepressant options during pregnancy.