A Prospective, Naturalistic, Blinded Study of Early Neurobehavioral Outcomes for Infants Following Prenatal Antidepressant Exposure

Department of Psychiatry, UCLA Mood Disorders Research Program, 300 Medical Plaza, Ste 1544, Los Angeles, CA 90095, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 05/2011; 72(7):1002-7. DOI: 10.4088/JCP.10m06135
Source: PubMed


This study examined the potential effects of antidepressant exposure in pregnancy on early infant neurobehavioral outcomes.
In this prospective, naturalistic study, neurobehavioral assessments using the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) were completed by blinded raters between March 2001 and August 2005 on 64 infants who were born to mothers in 1 of 3 categories: (1) women with a history of DSM-IV-diagnosed major depressive disorder (MDD) who were treated with antidepressants during pregnancy, (2) women with a history of DSM-IV-diagnosed MDD who discontinued or chose not to be treated with antidepressants during pregnancy, and (3) a nonpsychiatric control group. Summary scores for the BNBAS were obtained within the first week of life and at 6 to 8 weeks of age.
No significant differences were observed between groups at either the first week after delivery or at 6 to 8 weeks of age on any of the summary scores for the 7 major clusters of the BNBAS.
Antidepressant exposure during pregnancy does not appear to have major adverse effects on indices of early infant neurobehavioral development during the first 2 months of life as assessed by the BNBAS. While this finding is encouraging, further studies with larger samples and longer follow-up are needed.

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    • "Although signs of poor neonatal adaptation were demonstrated in nearly 30% of SSRI exposed infants, later developmental outcome was normal, without differences between infants affected by neonatal adverse reactions and asymptomatic infants. A recent study which examined early infant neurobehavioral development, (as measured by the Brazelton Neonatal Behavioral Assessment Scale), at 1 week and then 6-8 weeks of age found no difference in infants exposed to antidepressants compared to controls [29]. In contrast, a number of studies [19] [22] and a meta-analysis [18] have found exposure to antidepressants is associated with altered neurobehaviour in neonates. "
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    ABSTRACT: This chapter will discuss the biology of exposure to antidepressants during pregnancy as it interacts with fetal neurodevelopment. A systematic review of prevalence rates in pregnancy found 12% of women in third trimester meet criteria for depression and the Avon Longitudinal Study of Parents and Children (ALSPAC) found that more women were depressed at 32 weeks pregnant than 8 weeks postpartum. Untreated depression in pregnancy has been associated with increased pregnancy complications, poorer child development and increased risk of postnatal depression. While psychological treatments are indicated for many women with antenatal depression, pharmacological treatment may be indicated for those who either don"t respond, have moderate to severe depressive symptoms, or don"t have access to psychological treatments. Antidepressants may also be indicated for women with Anxiety Disorders. The most commonly prescribed antidepressants are the selective serotonin reuptake inhibitors (SSRIs). Rates of prescription in North America for antidepressants in pregnancy are rising yet the implications for exposure on the child"s longer term neurodevelopment are still relatively unknown. Until now, the limited number of studies has not revealed any effects on global cognitive function. Yet there have been 5 studies published recently which suggest an effect of exposure on psychomotor development and a single, unreplicated study which
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    ABSTRACT: Antidepressants are used commonly in pregnancy. Physicians who provide health care for pregnant women with depression must balance maternal well-being with potential fetal risks of these medications. Over the last decade, scores of original and review articles have discussed whether selective serotonin reuptake inhibitors-selective serotonin norepinephrine reuptake inhibitors possess risks to the fetus; however, very little has been done to integrate these potential risks, if they exist, into an overall context of a benefit:risk ratio. This review aims at presenting an updated analysis of fetal and maternal exposure to selective serotonin or norepinephrine reuptake inhibitors to allow an evidence-based benefit:risk ratio. When a psychiatric condition necessitates pharmacotherapy, the benefits of such therapy far outweigh the potential minimal risks of cardiac malformations, primary pulmonary hypertension of the newborn infant, or poor neonatal adaptation syndrome.
    American journal of obstetrics and gynecology 02/2012; 207(3):157-63. DOI:10.1016/j.ajog.2012.02.009 · 4.70 Impact Factor
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    ABSTRACT: Perinatal psychiatric disorders are important because of their adverse effects on pregnancy outcomes. The aim of this review is investigate psychotropic drugs in the management of antenatal psychiatric disorders with emphasis on the risk of harmful effects. A systematic review of published electronic literature between January 2000 and August 2011 was conducted using the following keywords: pregnancy, pregnancy complications, neonatal complications, congenital anomalies, infant/child development, antidepressants, antipsychotics, and lithium. The search was conducted for each class of psychotropic agents. Further hand searches were conducted. Anticonvulsants were excluded. Antidepressants are associated with increased risk of spontaneous abortions, stillbirths, preterm deliveries, respiratory distress, endocrine and metabolic disturbance. There is evidence of discontinuation syndrome and of increased risk of cardiac defects. Antipsychotics are associated with increased gestational weight and diabetes and with increased risk of preterm birth. The effects of antipsychotics on birth weight are inconclusive. In addition, the findings in relation to malformations are inconclusive. Lithium is associated with increased birth complications such as polyhydramnios, pre-eclampsia, respiratory distress syndrome, hypotonia, and preterm birth. Lithium has previously been associated with markedly increased risk of Ebstein's anomaly. However, recent re-evaluation of the data casts doubt on the previous estimates. There is evidence that lithium is associated with cardiac septal defects. Psychotropic drugs remain an important treatment option during pregnancy to properly manage symptoms of psychiatric diseases. Clinicians need to remain aware of the potential risk of adverse effects associated with psychotropic drug treatment.
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