Is maternal use of selective serotonin reuptake inhibitors in the third trimester of pregnancy harmful to neonates?

Koren, Gideon; Matsui, Doreen; Einarson, Adrienne; Knoppert, David; Steiner, Meir

doi:10.1503/cmaj.1041100

Cited by 80 publications

(57 citation statements)

References 14 publications

(14 reference statements)

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“…According to the majority of studies, the use of SSRIs and TCAs in pregnancy imposes no increased risk for malformations (Altshuler et al 2001;Alwan et al 2007;Austin and Mitchell 1998;Emslie and Judge 2000;Ericson et al 1999;Hogberg and Wang 2005;Kallen and Otterblad Olausson 2007;Koren et al 2005;Lattimore et al 2005;Malm et al 2005;Misri et al 2000a;Misri et al 2000b;Nordeng and Spigset 2005;Ramos et al 2008), although some reports have raised concerns about fetal cardiac effects, newborn persistent pulmonary hypertension, respiratory distress and other effects (ACOG 2006;Oberlander et al 2008). However, it is recommended to avoid paroxetine use among pregnant women or women planning to become pregnant, if possible (ACOG 2006).…”

Section: Pregnancymentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

712

410

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In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo-or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/ SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.

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Section: Pregnancymentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

712

410

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“…Most studies [3][4][5][6][7][8][9] have reported relatively consistent findings on the adverse effects of SSRI use during pregnancy, which include neonatal withdrawal syndrome, low birth weight, and preterm birth. Many studies [10][11][12] have indicated no major fetal malformations higher than the baseline population risk of 1% to 3% with use of SSRIs during pregnancy.…”

mentioning

confidence: 99%

Congenital Heart Disease Associated With Selective Serotonin Reuptake Inhibitor Use During Pregnancy

Wichman

Moore

Lang

et al. 2009

Mayo Clinic Proceedings

144

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OBJECTIVE:To determine the risk of congenital cardiac abnormalities associated with use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy. PATIENTS AND METHODS:We conducted a retrospective review of the medical records of all pregnant women presenting at Mayo Clinic's site in Rochester, MN, from January 1, 1993, to July 15, 2005, and identified 25,214 deliveries. A total of 808 mothers were treated with SSRIs at some point during their pregnancy. We reviewed the medical records of the newborns exposed to SSRIs during pregnancy to analyze their outcomes, specifically for congenital heart disease and persistent pulmonary hypertension of the newborn. RESULTS:Of the study patients, 808 (3.2%) took an SSRI at some point during the antenatal period. Of the 25,214 deliveries, 208 newborns (0.8%) were diagnosed as having congenital heart disease. Of the 808 women exposed to SSRI during pregnancy, 3 (0.4%) had congenital heart disease compared with 205 (0.8%) of the 24,406 women not exposed to an SSRI (P=.23). Of the total number of deliveries, 16 newborns were diagnosed as having persistent pulmonary hypertension of the newborn, none of whom had exposure to SSRIs (P>.99). © 2009 Mayo Foundation for Medical Education and ResearchR ecent data indicate that approximately 10% to 15% of women will have depression at some point during pregnancy or the postpartum period. 1,2 Untreated depression during pregnancy may lead to poor outcomes, including low birth weight, preterm delivery, or lower Apgar scores; poor prenatal care; failure to recognize or report signs of labor; and an increased risk of fetal abuse, neonaticide, or suicide. 1,2 Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacotherapy for depression, and SSRI use during pregnancy has been well documented.Overall, data regarding the use of SSRIs during pregnancy have been reassuring. Most studies 3-9 have reported relatively consistent findings on the adverse effects of SSRI use during pregnancy, which include neonatal withdrawal syndrome, low birth weight, and preterm birth. Many studies 10-12 have indicated no major fetal malformations higher than the baseline population risk of 1% to 3% with use of SSRIs during pregnancy. One study 13 has indicated increased risks for specific defects, whereas another study 14 noted an association between overall SSRI use during pregnancy and 3 distinct types of birth defects.Congenital heart disease (CHD) is recognized in approximately 0.4% to 1% of all live births, 15-17 and several studies have suggested that use of an SSRI, particularly paroxetine, may be associated with an increased risk of CHD. In particular, ventricular septal defects (VSDs) have been associated with use of paroxetine during the first trimester, 18-22 although a recent meta-analysis 23 that reviewed both previously published and unpublished data did not confirm this association. One report 20 showed a dose response in neonates exposed to paroxetine during the first trimester; infants exposed to paroxetine at dosag...

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“…6 By definition, antidepressant abstinence or discontinuation syndrome occurs in the first few days after abrupt drug cessation, as after delivery, when the drug concentrations from the newborn's serum are not detectable or too low to have any biological effect; most common reported symptoms include irritability, sleep disturbances, abnormal crying, rigidity and tremor. 7 Diagnosis is usually performed by prenatal history, clinical findings and Finnegan score. Finnegan score was originally developed to diagnose neonatal opioid abstinence 8 but has also been used to assess neonatal symptoms in SSRI exposed infants.…”

Section: Discussionmentioning

confidence: 99%

Neonatal abstinence syndrome due to prenatally citalopram exposure: A case report

et al. 2017

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Neonatal abstinence syndrome (NAS) due to prenatally exposure to citalopram can develop during the first days of life even with low dose of drug exposure. Supportive management is the first choice but phenobarbital can be used in treatment of this syndrome. Breastfeeding should not be interrupted. These neonates should be followed both for NAS and neurodevelopmental outcome. In this article, we reported a newborn with NAS due to citalopram exposure with a lower dose than previously reported in the literature, during the last six months of pregnancy. Phenobarbital was used because of non-pharmacological treatment failure.

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Is maternal use of selective serotonin reuptake inhibitors in the third trimester of pregnancy harmful to neonates?

Cited by 80 publications

References 14 publications

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Congenital Heart Disease Associated With Selective Serotonin Reuptake Inhibitor Use During Pregnancy

Neonatal abstinence syndrome due to prenatally citalopram exposure: A case report

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