To treat or not to treat: maternal depression, SSRI use in pregnancy and adverse neonatal effects
ABSTRACT Recent pharmaceutical company and regulatory body circulars warning against the use of selective serotonin reuptake inhibitors (SSRIs) in late pregnancy have left clinicians in somewhat of a quandary as to how to manage their more severely depressed patients in pregnancy. Conversely, up to 75% of depressed women ceasing their antidepressants periconceptually will relapse. Studies reporting on adverse neonatal outcomes following exposure to SSRIs in the latter half of pregnancy suggest that the fetus is exposed to significant concentrations of these medications during this time. Adverse neonatal effects affecting the respiratory, gastrointestinal and neurological systems are, however, predominantly mild and self-limiting. One small retrospective case study suggests that SSRI exposure in the latter half of pregnancy may be associated with an increased risk of persistent pulmonary hypertension of the neonate (PPHN), however, the absolute risk of developing PPHN remains very small and these findings will require replication with a prospective study. While the studies to date suggest the need to closely monitor SSRI-exposed neonates in the immediate postnatal period, preferably with a neonatal withdrawal scale and access to neonatology services, there is currently no clear argument for women to be weaned off their SSRI in late pregnancy. The decision to use SSRIs at this time will have to be made on a case-by-case basis in close consultation with the mother and her partner.
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ABSTRACT: Pregnancy in opioid-dependent women is a major public health issue. Women who are afflicted by opioid addiction are a highly vulnerable group of patients frequently becoming pregnant unplanned and at risk of adverse pregnancy outcomes and peri-natal complications. Opioid agonist maintenance treatment is the best option for the majority of women. Ideally, early and closely monitored treatment in an interdisciplinary team approach including social workers, nurses, psychologists, psychiatrists, gynecologists, anesthesiologists, and pediatricians should be provided. The treatment of comorbid psychiatric conditions, the resolution of financial, legal, and housing issues, and the psychosocial support provided have a significant effect on optimizing pregnancy outcomes. This paper aims to update health professionals in the field of gynecology and obstetrics on the latest optimal treatment approaches for mothers suffering from opioid dependence and their neonates.Obstetrics and Gynecology International 02/2012; 2012:195954. DOI:10.1155/2012/195954
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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.Neuropsychiatric Disease and Treatment 08/2013; 9:1257-1266. DOI:10.2147/NDT.S36394 · 2.15 Impact Factor
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ABSTRACT: Infants exposed to antidepressants in utero, specifically those in the class of selective serotonin reuptake inhibitors (SSRI) or selective norepinephrine reuptake inhibitors (SNRI), are at risk for experiencing a constellation of postnatal symptoms that may interfere with transition, including respiratory distress; neurobehavioral issues such as seizures, poor state regulation, and tremors; hypoglycemia; feeding issues; and poor weight gain. There is debate regarding the prevalence of these symptoms and whether they represent a transient neonatal behavioral syndrome brought on by immediate cessation of exposure to the SSRI/SNRI at birth, a withdrawal syndrome, or another entity such as serotonin toxicity. Recent concerns point to increased risk of low birth weight, prematurity, and persistent pulmonary hypertension, with possible impact on long-term neurodevelopmental outcome. The discontinuation of antidepressant therapy in the third trimester may not be feasible and may have more negative outcomes for both the mother and infant. The literature on SSRI/SNRI use during pregnancy and the effects on the newborn require critical examination before recommendations can be made for routine postpartum monitoring of these infants. This article will critically evaluate the literature regarding perinatal outcomes for infants exposed to SSRI/SNRIs in utero, suggesting practice implications for nursing, medical care, and family education and support for those exposed. There is a growing body of evidence to support a clinical set of symptoms that can be referred to as poor neonatal adaptation; however, insufficient evidence exists to support serotonin toxicity or withdrawal.Newborn and Infant Nursing Reviews 09/2008; 8(3):123-130. DOI:10.1053/j.nainr.2008.06.006