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Is Prenatal SSRI Exposure Harmful to Newborns?

Infants born to mothers on SSRIs should be monitored closely for neonatal abstinence syndrome and persistent pulmonary hypertension.

When taken by pregnant women, selective serotonin reuptake inhibitors (SSRIs) cross the placenta and have the potential to affect newborns. Although SSRIs have not been associated with congenital malformations, some evidence suggests that they are associated with neonatal complications such as neonatal abstinence syndrome (NAS) and persistent pulmonary hypertension (PPH). Two studies point to such risks.

Researchers in Israel assessed NAS in 60 full-term newborns whose mothers had taken SSRIs (mostly paroxetine) during the third semester and in 60 unexposed control infants matched for birth weight, gender, and gestational age. Among the 60 exposed infants, 18 (30%) exhibited NAS (based on the Finnegan score for evaluating neonatal narcotic withdrawal). Eight of the exposed newborns (13%) had severe NAS symptoms; symptoms peaked during the first 2 days of life in most infants but lasted until 4 days in others. None of the 60 control infants had NAS. A dose-response relation was observed between SSRI dose and NAS symptoms in paroxetine-exposed newborns. Subgroups were too small to compare risks for NAS associated with individual SSRIs.

In a nested case-control study drawn from a study of infants with birth defects, researchers in California compared SSRI use in 377 women whose infants had PPH and 836 matched controls. SSRI use after the 20th week of gestation was significantly associated with neonatal PPH (14 exposed infants developed PPH, vs. 6 controls; adjusted odds ratio, 6.1). Neither use of SSRIs before the 20th week of gestation nor use of other antidepressants any time during pregnancy was associated with PPH.

Comment: Effective treatment of depression during pregnancy (including cognitive behavioral therapy, psychotherapy, and pharmacotherapy) benefits both mother and newborn, but the risks of pharmacotherapy should be considered in treatment decisions, and a detailed maternal drug history at the time of birth is important. Infants born to mothers on SSRIs should be monitored closely for NAS and PPH; those with NAS should not be discharged until NAS symptoms resolve. The findings of both studies are consistent with other reports that SSRI use late in pregnancy is associated with neonatal complications (JWPAM March 28 2005). Other researchers continue to examine the long-term effects of in utero SSRI exposure.

— Cornelius W. Van Niel, MD, and Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine March 10, 2006

Citation(s):

Levinson-Castiel R et al. Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adolesc Med 2006 Feb; 160:173-6.

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Chambers CD et al. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med 2006 Feb 9; 354:579-87.

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• Medline abstract (Free)