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SSRI Use During Pregnancy Associated with 'Newborn Abstinence Syndrome'

Newborn babies of women who took selective serotonin reuptake inhibitors (SSRIs) during pregnancy may be at a much higher risk of neonatal abstinence syndrome-a type of withdrawal-according to a new study.

Symptoms of neonatal abstinence syndrome include high-pitched crying, tremors and disturbed sleep, according to a study published in the February issue of Archives of Pediatrics & Adolescent Medicine.

Depression affects 10-25% of women during their lifetime. Pregnancy and its accompanying stressors often aggravate depression and increase the need for medical intervention, according to study authors Rachel Levinson-Castiel, MD, of the Children's Medical Center of Israel, Petah Tiqwa, Israel, and colleagues.

Selective serotonin reuptake inhibitors are commonly used to treat depression. Because SSRIs cross the placenta, many investigations have been undertaken regarding the effects on the fetus of maternal intake of SSRIs. Although SSRIs are not associated with an increased incidence of major congenital malformations, evidence is growing that SSRIs are associated with a neonatal abstinence syndrome (NAS).

Clinical Trial

Dr Levinson-Castiel and colleagues' aim was to compare the incidence and clinical characteristics of NAS in neonates who were exposed to SSRIs in utero, versus those who were not exposed.

The investigators examined 120 babies born between January 1, 2002, and August 31, 2004 at Rabin Medical Center in Israel. Mothers of 60 of these babies took SSRIs for prolonged periods, including during the third trimester. SSRIs taken included fluoxetine, paroxetine, citalopram, sertraline and the dual serotonin-noradrenaline reuptake inhibitor, venlafaxine.

The researchers assessed these 60 infants, and 60 control infants with no exposure to SSRIs, two hours after birth and afterward at regular intervals, if they displayed NAS symptoms.

Of the 60 infants with SSRI exposure, 18 (30%) showed symptoms of NAS, and eight of these cases (13%) were severe NAS. The most common NAS symptoms were tremor, gastrointestinal problems, abnormally increased in muscle tone, sleep disturbances and high-pitched cries. None of the neonates with NAS symptoms required treatment, according to the researchers, and none of the 60 control infants developed NAS.

"The high prevalence of neonatal abstinence syndrome in infants exposed to SSRIs in utero should be brought to the attention of family physicians, psychiatrists, gynecologists, pediatricians and mothers," the authors write. "Because maternal depression during pregnancy also entails a risk to the newborn, the risk-benefit ratio of continuing SSRI treatment should be assessed."

The authors recommended that, in cases where a pregnant woman and her physician deem the use of SSRI medication necessary, the doctor should prescribe the minimum dose and number of drugs that would effectively treat the condition.

The also recommended that, because infants severely affected by NAS show peak symptoms within the first 48 hours of life, they should be closely observed for at least this period.

"Follow-up of exposed infants, particularly those who develop severe symptoms, is needed to assess the long-term effects of prolonged exposure to SSRIs."

Neonatal Abstinence Syndrome After In Utero Exposure to Selective Serotonin Reuptake Inhibitors in Term Infants. Rachel Levinson-Castiel, Archives of Pediatrics & Adolescent Medicine, volume 160, pages 173-176, February 2006.

Posted: February 2006