Neonatal Outcomes in Maternal Depression in Relation to Intrauterine Drug Exposure

Abstract

Background: SSRIs (Selective Serotonin Reuptake Inhibitors) are the most useful drugs to treat depression during pregnancy. Intrauterine exposure to SSRIs may increase the risk of growth restriction, preterm birth and neonatal complications. However, advantages in treating depression seem to exceed potential drug side effects in respect un-treated depression. SSRIs undergo extensive hepatic first-pass metabolism with the involvement of several cytochrome P450 (CYPs) enzymes. Genetic polymorphisms may influence the expression and activity of CYPs genes. The first aim of this study was to evaluate neonatal outcomes in depressed mothers exposed to SSRIs during pregnancy. SSRIs pharmacogenetics was also evaluated in a subset of mothers and fetuses. Methods: In this case-control study, cases ( n = 42) were Caucasian women with a diagnosis of depression and/or anxiety, treated with SSRIs for the whole pregnancy. Controls ( n = 85) were Caucasian women without a psychiatric diagnosis and not exposed to SSRIs during pregnancy. Exclusion criteria for both groups were other psychotropic drugs, anti-epileptics, drug of abuse, alcohol addiction, maternal or fetal infectious diseases, fetal/neonatal chromosomal genetic abnormalities. Maternal and fetal blood samples were obtained at delivery to analyze genotype in 33 cases . Results: The population was homogenous for demographic, anthropometric, socio-economic and obstetric variables except for smoking and mean hemoglobin values before delivery. Obstetric features were comparable. Newborns exposed to SSRIs during fetal life were significantly more likely to be Low Birth Weight (LBW) (birth weight <2,500 g) ( p = 0.01), had significantly lower mean Apgar scores at 1' ( p = 0.006) and at 5' ( p = 0.023) and worse Apgar distribution at 1' ( p = 0.017) and at 5' ( p = 0.013). Fifty-six percent of newborns presented one or more symptoms consistent with poor neonatal adaptation syndrome (PNAS). Pharmacogenetic analysis at delivery did not show significant differences in the frequencies of obstetric or neonatal complications in relation to polymorphisms. Conclusions: We found that newborns exposed to SSRIs are at increased risk of poor neonatal outcomes in terms of low birth weight, low Apgar scores and, clinically, poor neonatal adaptation syndrome. Preliminary pharmacogenetic analysis showed that the degree of CYPs alterations, that depends on polymorphisms, may influence neonatal outcomes.

“We do not know how to screen and provide treatment”: a qualitative study of barriers and enablers of implementing perinatal depression health services in Ethiopia

“…Antenatal and postnatal depression prevalences as high as 32% [ 93 ] and 34% [ 5 ], respectively have been reported in Ethiopia, and perinatal depression is documented as having multifaceted consequences for children [ 8 , 94 ] and mothers [ 95 ]. In this context, the American Psychiatric Association [ 96 ], College of Obstetrics and Gynaecology [ 97 ], US Preventive Service Task Force [ 98 ], and the World Health Organization [ 99 ] have recommended screening and treatment. The effectiveness of screening and preliminary counselling interventions in preventing perinatal depression has also been documented in recent literature [ 90 – 92 ].…”

Marital communication skills training to promote marital satisfaction and psychological health during pregnancy: a couple focused approach

“…The existing evidence shows that pregnancy depression is associated with an increased risk of preeclampsia and preterm labor as well as low birth weight [4][5][6]. In addition, the use of Selective Serotonin Reuptake Inhibitors, which is useful in the treatment of pregnancy depression, has recently been reported to increase fetal complications including low birth weight and decreased neonatal Apgar score [7].…”

Effect of Selected Antidepressants on Placental Homeostasis of Serotonin: Maternal and Fetal Perspectives

“…Prenatal use of serotonin reuptake inhibitors (SRIs) to treat maternal depression has been identified as a potential risk factor for perinatal complications such as preterm delivery, intrauterine growth restriction, pulmonary hypertension, and preeclampsia [ 19 , 53 , 54 , 55 ]. Moreover, epidemiological studies have associated prenatal exposure to SRIs with increased risks of autism spectrum disorders and mental diseases [ 56 , 57 , 58 ].…”