The use of psychotropic medication during pregnancy: how about the newborn?

Abstract

Infants are at risk of developing symptoms of Poor Neonatal Adaptation (PNA) after exposure to psychotropic drugs in utero. Such symptoms are largely similar after exposure to antidepressants, antipsychotics and benzodiazepines and consist of mostly mild neurologic, autonomic, respirator and gastro-intestinal abnormalities. Most symptoms develop within 48 hours after birth and last for 2–6 days. After exposure to Selective Serotonin Reuptake Inhibitors (SSRIs), mirtazapine or venlafaxine in utero, breastfeeding is presumably protective for development of PNA. The dosage of antidepressants does not seem to be related to the risk of PNA. In order to objectify possible symptoms of PNA, observation of mother and child at the maternity ward is advisable. If PNA symptoms do not occur, an observation period of 48–72 hours is sufficient. This applies to all types of psychotropic drugs. When PNA symptoms are present it is advisable to observe the infant until the symptoms are fully resolved. Observation can be performed by trained nurses using the Finnegan scoring list. This observation list should be administered every 8 hours. Interpretation of the scores should be carried out by a paediatrician. In most cases symptoms are non-specific. Therefore other diagnoses, such as infection or neurologic problems, have to be excluded. When there is any doubt on possible intoxications during pregnancy, toxicological urine screening is indicated. Most cases of PNA are mild, of short duration and self-limiting without need for treatment. Supporting measures such as frequent small feedings, swaddling and increase of skin to skin contact with the mother is usually sufficient. In case of severe PNA it is advised to admit the infant to the Neonatal Care Unit (NCU). Phenobarbital is a safe therapeutic option. There seem to be no major long term effects; however, additional studies are necessary in order to draw definite conclusions.

Neonatal Abstinence Syndrome

“…61,62 Approximately 1.8% of pregnant mothers use antidepressants and 3.0% use benzodiazepines. 63,64 Selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and benzodiazepines are associated with NAS. 61,64 Women with mental health disorders are also at increased risk of substance abuse.…”

Effect of antidepressants use in pregnancy on foetus development and adverse effects in newborns

“…The analysis was inconclusive as to which of the drugs is associated most strongly with the risk of PNAS in newborns, but it was established that the symptoms may affect from 20% to 77% of children exposed to SSRIs during foetal life [35]. Some of the studies also indicated an increased risk linked to the use of paroxetine and fluoxetine [36]. When using venlafaxine, the risk of PNAS is comparable to that associated with the use of SSRIs [37].…”

Pharmacotherapy of obsessive-compulsive disorder during pregnancy: a clinical approach

“…30,91 However, two SSRIs including fluoxetine and particularly paroxetine are not appropriate for first-line treatment because these drugs are the most frequently associated with congenital malformations and PNAS. 27,28,35,45,95 Nonetheless, these antidepressants may be chosen in women with OCD who do not respond or cannot tolerate other SSRIs due to low elevation of absolute risk of birth defects. 27,28,96,97 Sertraline and citalopram/escitalopram seem to be a more favorable option in the pregnancy period.…”