Neonatal Hypotonia Following in Utero Exposure to Antidepressant Drugs

Desaunay, Pierre; Dolladille, Charles; Chrétien, Basile; Eudes, Léa-Gabrielle; Fédrizzi, Sophie; Alexandre, Cénéric; Apter, Gisèle; Alexandre, Jonas; Guénolé, Fabian

doi:10.1016/j.jpeds.2022.02.028

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…We ascertained maternal inpatient and outpatient International Classification of Diseases (ICD) diagnoses of depression and anxiety during pregnancy (online supplemental file 1) from existing KPNC databases. 28 We classified the severity of depression symptoms using each mother's maximal Patient Health Questionnaire-9 (PHQ-9) score as follows: none or mild (0-9), moderate (10)(11)(12)(13)(14), moderate to severe (15)(16)(17)(18)(19), severe (20)(21)(22)(23)(24)(25)(26)(27). 29 We extracted demographic and clinical data from existing databases 30 : birth year; maternal age, self-reported race/ethnicity and parity; state-subsidised insurance, quartile of neighbourhood deprivation index; maternal type 2 diabetes, chronic hypertension and obesity (pre-pregnancy body mass index ≥30); mode of delivery, infant sex, birth weight and gestational age.…”

Section: Covariatesmentioning

confidence: 99%

“…Some studies have shown in utero SSRI exposure to be associated with delayed neonatal adaptation4 5 manifested by lower Apgar scores,6 7 respiratory distress8–10 and persistent pulmonary hypertension of the newborn11 12 leading to higher neonatal intensive care unit (NICU) admission rates 4 13. Transient, self-limited symptoms such as abnormal tone,14–17 jitteriness and irritability18 have also been described. The risk of more severe neurological conditions such as hypoxic-ischaemic encephalopathy (HIE)19 and seizures20 21 is unclear.…”

Section: Introductionmentioning

confidence: 99%

“…Past studies are limited by small sample size,5 10 16 19 ascertainment bias of both exposure and outcome of interest,4 5 17 19 reliance on administrative databases8 9 and the inability to differentiate the adverse effects of SSRIs themselves from the impact of maternal anxiety and depression on neonatal outcomes 9 10 22 23. Data on the relationship between the type and dose of SSRI treatment and adverse outcome are also needed.…”

Section: Introductionmentioning

confidence: 99%

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Maternal treatment with selective serotonin reuptake inhibitors during pregnancy and delayed neonatal adaptation: a population-based cohort study

Cornet,

Wu,

Forquer

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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ObjectiveSelective serotonin reuptake inhibitor (SSRI) use is common in pregnancy. It is associated with delayed neonatal adaptation. Most previous studies have not adjusted for the severity of maternal mental health disorders or examined the impact of SSRI type and dosage. We examined whether treatment with SSRIs in late pregnancy (after 20 weeks) is associated with delayed neonatal adaptation independent of maternal depression and anxiety.Design, setting and patientsRetrospective population-based birth cohort of 280 090 term infants born at 15 Kaiser Permanente Northern California hospitals, 2011–2019. Individual-level pharmacy, maternal, pregnancy and neonatal data were obtained from electronic medical records.ExposureDispensed maternal SSRI prescription after 20 weeks of pregnancy.Main outcome measuresDelayed neonatal adaptation defined as a 5 min Apgar score ≤5, resuscitation at birth or admission to a neonatal intensive care unit for respiratory support. Secondary outcomes included each individual component of the primary outcome and more severe neonatal outcomes (pulmonary hypertension, hypoxic-ischaemic encephalopathy and seizures).Results7573 (2.7%) infants were exposed to SSRIs in late pregnancy. Delayed neonatal adaptation occurred in 11.2% of exposed vs 4.4% of unexposed infants (relative risk 2.52 (95% CI 2.36 to 2.70)). After multivariable adjustment, there was an association between SSRI exposure and delayed neonatal adaptation (adjusted OR 2.14 (95% CI 1.96 to 2.32)). This association was dose dependent. Escitalopram and fluoxetine were associated with the highest risk of delayed neonatal adaptation.ConclusionsInfants exposed to SSRIs have increased risks of delayed adaptation in a type and dose-dependent relationship, pointing toward a causal relationship.

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