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Examining The Effects of Sertraline at Time of Delivery

Authors:
  • Marchand Institute for Minimally Invasive Surgery
  • Marchand Institute for Minimally Invasive Surgery

Abstract

he antidepressant, Sertraline is a commonly prescribed selective serotonin reuptake inhibitor (SSRI). SSRI’s account for upwards of 80% of the prescribed antidepressants on the market and are used by approximately 3% of pregnant women in Europe as well as 8% of pregnant women in the United States7. Antidepressants, including Sertraline, cross the placenta and fetal blood brain barrier4. As such, it’s important we continue to investigate the short and long-term effects of SSRI use in pregnancy. Following SSRI exposure in the third trimester, newborns may experience respiratory distress, cyanosis, apnea, seizures, temperature instability, hypoglycemia and/or hypo/hypertonia4. Fetal exposure to Sertraline has been linked to decreased Apgar scores3. he purpose of this study is to document a known complication of Sertraline on a newborn at time of delivery and to explore the current literature regarding SSRI exposure during pregnancy. This is a retrospective, observational case study in which the cause for hypoxia in an otherwise healthy newborn at time of delivery is examined. The case was reviewed and a literature review was performed regarding commonly experienced complications of SSRI and specifically antenatal Sertraline exposure on infants. The infant’s mother, a 17 year old, white, gravida 1 now para 1001 female complained of feelings of anxiety and depression at her routine obstetrical appointment in the second trimester. She was prescribed Sertraline 50mg daily as a first line therapy. Patient reported good results and continued to take the medication as prescribed. In her third trimester, the patient complained of increasing anxiety and panic attacks. Her dose was increased to 100mg daily. Due to worsening flank pain throughout the pregnancy, pt underwent amniocentesis and was cleared for induction at 38 weeks. The patient had a normal vaginal delivery at 38 weeks and 4 days. Patient delivered a baby boy with apgars 3 and 6. Loose nuchal x1 was observed. The cord was clamped and cut.The baby exhibited hypoxia which was resolved with CPAP and supplemental oxygen. After resuscitation, the baby was taken to the nursery without further complication. The in utero Sertraline exposure may explain the hypoxia in the newborn at time of delivery in this case. Resuscitation is indicated in approximately 10% of newborns for various reasons6. While most documented effects of in utero SSRI exposure are both transient and mild, the association of SSRI exposure in newborns with the incidence of persistent pulmonary hypertension deserves further discussion. While more research is indicated for the effects of in utero SSRI exposure on newborns, the results of this literature review indicate that greater consideration should be given to the prescription of SSRIs as a first line treatment for antenatal depression. On a case-by-case basis, physicians should evaluate alternative treatments for depression, such as psychotherapy. Psychotherapy should be considered for patients who are candidates, such as those with mild depressive symptoms and no history of suicidal ideation or severe impairment of daily function2. Mood and anxiety disorders are common in women during their childbearing years3. As such, it is imperative that suitable treatment options, including SSRIs, are available. However, the effects of antenatal SSRI exposure on infants are not fully understood4. There is an increasing need for further studies to better examine the consequences of exposure to SSRIs and other antidepressants circa time of delivery. In the time being, physicians should understand the risks surrounding the use of SSRIs in pregnancy and feel comfortable weighing the risks and benefits with their patients5. When considering the appropriate therapy, patients should be made aware of all potential issues linked to SSRI use in pregnancy. We believe this level of counselling, in which the patient’s sense of autonomy is forefront, is vital to providing the highest standard of patient care, especially when the effects of antenatal exposure are not fully understood at this time.
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