Risk factors for poor neonatal adaptation after exposure to antidepressants <i>in utero</i>

Kieviet, Noera; Hoppenbrouwers, Chris; Dolman, Koert M.; Berkhof, Johannes; Wennink, H. J.; Honig, Adriaan

doi:10.1111/apa.12921

Cited by 25 publications

(20 citation statements)

References 25 publications

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“…This suggestion might have resulted in the transient and self-limiting neonatal adjustment syndrome. A study that supports our results revealed that newborns who were exposed to antidepressants in the prenatal period and were breastfed were less likely to develop poor neonatal adaptation syndrome than those who were fed by formula [33]. A metaanalysis revealed a lower ratio of breastfeeding in women who had antenatal depression than in nondepressed women [16].…”

Section: Discussionsupporting

confidence: 86%

Comparison of the groups treated with mirtazapine and selective serotonine reuptake inhibitors with respect to birth outcomes and severity of psychiatric disorder

Güngör

Öztürk

Atar

2019

Psychiatry and Clinical Psychopharmacology

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Objective: The literature provides very limited information on mirtazapine usage in the pregnancy period. The groups including pregnant women who used SSRI or mirtazapine as a single treatment, SSRI-mirtazapine combination treatment and unmedicated groups were compared with respect to illness severity and birth outcomes. Method: The study sample included 120 pregnant women; 40 women with SSRI usage, 16 women with mirtazapine usage, 18 women with combined SSRI-mirtazapine usage, 23 women with unmedicated psychiatric disorder and who elected not to take medication during their pregnancy or discontinued antidepressants by themselves, and 23 healthy control women. Results: No difference was obtained with regard to the gestation week of birth, birth weight, the duration of stay in the neonatal care unit among the SSRI, mirtazapine, SSRI-mirtazapine combination, unmedicated patient and control groups. The likelihood of a new diagnosis was highest in the mirtazapine group. The majority of pregnant women whose psychiatric disorders were more severe and more relapsed used SSRI-mirtazapine combination treatment. Conclusion: No difference was observed between the SSRI and mirtazapine usage in the pregnancy period with regard to the birth outcomes. Similar birth outcomes could present clinicians with the option of prescribing mirtazapine as a safe alternative to SSRI in the treatment of antenatal psychiatric patients.

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Section: Discussionsupporting

confidence: 86%

Comparison of the groups treated with mirtazapine and selective serotonine reuptake inhibitors with respect to birth outcomes and severity of psychiatric disorder

Güngör

Öztürk

Atar

2019

Psychiatry and Clinical Psychopharmacology

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“…In mother-infant dyads whereof the infants were formula-fed, the intervention rate was higher. An earlier study of our research group showed that formula-fed infants develop more symptoms of poor neonatal adaptation, which could explain this finding [24]. However, other factors, such as the type of psychotropic drugs (some are not compatible with breastfeeding) and severity of psychiatric disorder might also attribute to this relationship.…”

Section: Discussionmentioning

confidence: 81%

“…The type of underlying psychiatric disorder and severity of psychiatric symptoms might attribute to this relationship. PNA does not seem to be related to the antidepressant dosage [13, 24]. In mother-infant dyads whereof the infants were formula-fed, the intervention rate was higher.…”

Section: Discussionmentioning

confidence: 99%

Use of antidepressants during pregnancy in the Netherlands: observational study into postpartum interventions

Kieviet¹,

Jong²,

Scheele³

et al. 2017

BMC Pregnancy Childbirth

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BackgroundPsychiatric disorders and use of selective antidepressants during pregnancy can have negative effects on mother and infant postpartum. This study aimed to provide evidence-based recommendations on observation of antidepressant-exposed mother-infant dyads.MethodsIn this observational study, mother-infant dyads were observed for possible consequences of either the maternal psychiatric disorder or fetal exposure to selective antidepressants during pregnancy. These possible complications can lead to medical interventions, including 1. adjustment of antidepressants 2. admission to the psychiatric department 3. additional investigations due to indistinctness about the origin of neonatal symptoms 4. treatment of poor neonatal adaptation and 5. consultation of an external organization for additional care. The type, number and time to medical interventions were analyzed.ResultsIn 61% of the 324 included mother-infant dyads one or more intrventions were performed. Adjustment of antidepressants and treatment of poor neonatal adaptation were most prevalent. In 75% of dyads the final intervention was performed within 48 h.ConclusionsThe high prevalence and type of medical interventions requires professional observation of all mother-infant dyads exposed to selective antidepressants. In the absence of specialized home care, hospital admission is indicated whereby an observational period of 48 h seems sufficient for most dyads.

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“…There is also some evidence to suggest breastfeeding reduces the risk of developing symptoms. 14 More recent studies have suggested potential neurodevelopmental consequences beyond the first few days of life with research demonstrating lower motor scores and increased stress signs throughout the first month of life in babies of mothers treated with SSRIs compared with those with untreated depression. 15 Additionally, there is evidence of subtle electroencephalogram changes in neonates exposed to SSRIs in utero compared with healthy controls.…”

Section: Discussionmentioning

confidence: 99%

Variation in the management of SSRI-exposed babies across England

Thomas

Peacock

Bates

2017

bmjpo

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BackgroundDepression in pregnancy is commonly treated using selective serotonin reuptake inhibitors (SSRIs). A possible withdrawal syndrome following in utero exposure has been reported, but there is currently no UK guidance on the management of these neonates.MethodsAll 160 neonatal units in England were asked for information regarding their management of SSRI-exposed babies.ResultsResponses were obtained from 112/160 (70%) units. Only four units had a specific protocol for managing SSRI-exposed neonates. Twenty-one units (19%) conduct routine observations on exposed neonates, while 37 units (33%) would consider treating babies with signs of withdrawal or toxicity.ConclusionsVery few neonatal units in England have specific guidelines for the management of babies exposed to SSRIs in utero, with practice varying greatly between units. Further research is needed on the outcomes of SSRI-exposed babies to support development of standardised evidence-based guidelines to ensure all mothers and babies receive similar high-quality care.

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Risk factors for poor neonatal adaptation after exposure to antidepressants in utero

Abstract: Formula feeding and exposure to SSRIs were associated with development of PNA, but dosage was not.

Cited by 25 publications

References 25 publications

Comparison of the groups treated with mirtazapine and selective serotonine reuptake inhibitors with respect to birth outcomes and severity of psychiatric disorder

Comparison of the groups treated with mirtazapine and selective serotonine reuptake inhibitors with respect to birth outcomes and severity of psychiatric disorder

Use of antidepressants during pregnancy in the Netherlands: observational study into postpartum interventions

Variation in the management of SSRI-exposed babies across England

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