About one-third of infants in a recent study who were exposed to
antidepressants while in the womb experienced symptoms of neonatal abstinence
syndrome, which include tremors, disturbed sleep, gastrointestinal problems,
Most of the symptoms occurred within the first 48 hours after birth, but
the long-term effects of neonatal abstinence syndrome, if any, are unknown,
according to a report in the February Archives of Pediatric and Adolescent
Researchers from the Schneider Children's Medical Center of Israel studied
120 infants born at the Rabin Medical Center in Israel between January 2002
and August 2004.
Half of the infants in the sample were born to mothers who took one of the
selective serotonin reuptake inhibitors (SSRIs) either through the entire
pregnancy or during the last trimester.
Of the mothers who took SSRIs, 37 took paroxetine, 12 took fluoxetine,
eight took citalopram, two took venlafaxine, and one took sertraline.
The remaining 60 infants were born to mothers who did not take an SSRI
Researchers assessed the infants' health with blood tests and by monitoring
cardiorespiratory functioning and temperature. In addition, they used the
Finnegan Scale, which measures symptoms of neonatal abstinence syndrome
Of the 60 infants exposed to SSRIs in utero, 30 percent (18) exhibited
symptoms of NAS. None of the infants in the control group exhibited symptoms
When researchers measured severity of symptoms among the 18 NAS infants,
they found that eight had severe symptoms and 10 had mild symptoms. Six of the
eight infants with severe symptoms had been exposed to paroxetine in
In addition, three of the infants exposed to SSRIs for the complete
pregnancy had major congenital anomalies, including ventricular septal defect,
hydronephronsis, and cleft palate. One of the newborns in the control group
Gil Klinger, M.D., one of the study's investigators, told Psychiatric
News that most of the mild symptoms in newborns subsided within a few
days. "Of the severely affected infants, two had seizures, which
resolved without intervention." Klinger is a senior neonatologist at
Schneider Children's Medical Center.
Though none of the short-term symptoms were life-threatening, he said,"
the long-term effects of SSRIs on newborns are unknown."
Klinger acknowledged that "depression also entails a risk to a
pregnant woman and her fetus and should also be controlled—we are not
recommending discontinuation of medications during pregnancy; however,
sometimes SSRIs are given for very mild indications, and in these
circumstances the risk-benefit ratio may not be in favor of giving
In other research, a case-controlled study published in February revealed a
slight risk of a relatively serious health problem for newborns of mothers
taking antidepressants during late pregnancy.
Researchers found that mothers who took SSRIs after the 20th week of
gestation were six times as likely as those who did not take the
antidepressants in late pregnancy to have newborns with persistent pulmonary
Researchers recruited a sample of 377 women whose infants had pulmonary
hypertension and 836 control women and their healthy infants from nearly 100
medical centers in Boston, Philadelphia, San Diego, and Toronto from 1998 to
2003. They gathered information on the mothers' medical and obstetrical
histories and past antidepressant usage. They assessed infants for pulmonary
The researchers found that 14 infants with pulmonary hypertension had been
exposed to an SSRI during late pregnancy, while only six infants in the
control group—those without the condition—had been exposed to
When researchers analyzed the association between SSRI use anytime during
pregnancy and pulmonary hypertension in newborns, however, they found no
elevated risk. Only use of SSRIs after the 20th week of gestation was
significantly associated with pulmonary hypertension.
According to the report in the February 9 New England Journal of
Medicine, newborns with the condition "are typically full-term or
near-term infants without associated congenital anomalies who present shortly
after birth with severe respiratory failure requiring intubation and
Christina Chambers, Ph.D., M.P.H., the study's lead investigator,
emphasized that the relative risk for infants is low—only about 6 to 12
women per 1,000 who use SSRIs late in pregnancy will have babies with
pulmonary hypertension. "About 99 percent of women exposed to one of
these medications late in pregnancy will deliver an infant unaffected by
pulmonary hypertension," she told Psychiatric News.
Chambers is an assistant professor of pediatrics at the University of
California, San Diego School of Medicine.
Though the findings could not prove a causal association between fetal
exposure to SSRIs and pulmonary hypertension, Chambers noted that one effect
of SSRIs is to reduce the production of nitric oxide, a vasodilator."
SSRIs also boost levels of serotonin," she added, "which
has vasoconstrictive properties."
Chambers also noted that even though there is low risk of pulmonary
hypertension among newborns of mothers who take SSRIs late in pregnancy, the
finding "should be factored into the many things an expectant mother
must consider when she is deciding whether to take an SSRI during
An abstract of "Neonatal Abstinence Syndrome After in Utero
Exposure to Selective Serotonin Reuptake Inhibitors in Term Infants" is
An abstract of "Selective Serotonin-Reuptake Inhibitors and Risk of
Persistent Pulmonary Hypertension of the Newborn" is posted at<http://content.nejm.org/cgi/content/abstract/354/6/579>.▪
Arch Pediatr Adolesc Med2005160173