Perinatal Outcome Following Third Trimester Exposure to Paroxetine

Costei, Adriana Moldovan; Kozer, Eran; Ho, Tommy; Itô, Shinya; Koren, Gideon

doi:10.1001/archpedi.156.11.1129

Cited by 238 publications

(194 citation statements)

References 10 publications

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“…Data on neonatal outcomes at birth were obtained from the neonatal health records including gestational age at birth, birth weight, length, head circumference, Apgar scores at 1 and 5 min, and whether the infant exhibited symptoms of postnatal adaptation syndrome-a cluster of symptoms reported in ~30% of neonates exposed to SRIs in utero (28) including rapid breathing, respiratory distress, jitteriness, and abnormal tone (29)(30)(31)(32).…”

Section: Maternal Characteristics and Neonatal Datamentioning

confidence: 99%

Prenatal exposure to serotonin reuptake inhibitor antidepressants and childhood behavior

2015

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Background: Animal research has suggested that prenatal serotonin reuptake inhibitor (SRI) antidepressant exposure causes increased anxiety-like behaviors in adulthood. We examined whether in utero SRI exposure influenced externalizing and internalizing behaviors in children at 3 y and again at 6 y of age. Methods: We recruited women in their second trimester of pregnancy from primary maternity care providers in Vancouver British Columbia, Canada. We compared the internalizing, externalizing, and the anxious and attention subscales of the internalizing behaviors scores of children exposed to SRIs and children not exposed to SRIs at age 3 and age 6. results: We included 110 mother-child pairs (44 exposed to SRI and 66 not exposed). Higher levels of internalizing and anxious behaviors were reported in SRI exposed children at both 3 and 6 y of age compared with children who were not exposed (F = 7.52, P = 0.0072 and F = 7.91, P = 0.0058, respectively). The fully adjusted hierarchical regression models indicated a positive and significant relationship between SRI exposure and increased internalizing and anxious behaviors even when controlling for maternal mood during pregnancy, postpartum and childhood. conclusion: SRI exposure was associated with sustained higher levels of internalizing behaviors in early childhood even when controlling for maternal depression.

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Section: Maternal Characteristics and Neonatal Datamentioning

confidence: 99%

Prenatal exposure to serotonin reuptake inhibitor antidepressants and childhood behavior

2015

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“…Children exposed to SSRIs in utero have been followed for up to 72 months postnatally and have not been reported to display increased behavioral abnormalities compared to unexposed children although they have been reported to display subtle changes in motor development and in motor movement control (Costei et al, 2002;Nulman et al, 2002;Casper et al, 2003). However, no study has followed such children beyond early childhood.…”

Section: Introductionmentioning

confidence: 99%

Neonatal Antidepressant Exposure has Lasting Effects on Behavior and Serotonin Circuitry

Maciąg

Simpson

Coppinger

et al. 2005

Neuropsychopharmacol

274

275

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A significant fraction of infants born to mothers taking selective serotonin reuptake inhibitors (SSRIs) during late pregnancy display clear signs of antidepressant withdrawal indicating that these drugs can penetrate fetal brain in utero at biologically significant levels. Previous studies in rodents have demonstrated that early exposure to some antidepressants can result in persistent abnormalities in adult behavior and indices of monoaminergic activity. Here, we show that chronic neonatal (postnatal days 8-21) exposure to citalopram (5 mg/kg, twice daily, s.c.), a potent and highly selective SSRI, results in profound reductions in both the rate-limiting serotonin synthetic enzyme (tryptophan hydroxylase) in dorsal raphe and in serotonin transporter expression in cortex that persist into adulthood. Furthermore, neonatal exposure to citalopram produces selective changes in behavior in adult rats including increased locomotor activity and decreased sexual behavior similar to that previously reported for antidepressants that are nonselective monoamine transport inhibitors. These data indicate that the previously reported neurobehavioral effects of antidepressants are a consequence of their effects on the serotonin transporter. Moreover, these data argue that exposure to SSRIs at an early age can disrupt the normal maturation of the serotonin system and alter serotonin-dependent neuronal processes. It is not known whether this effect of SSRIs is paralleled in humans; however, these data suggest that in utero, exposure to SSRIs may have unforeseen long-term neurobehavioral consequences.

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“…1 Some studies report that third trimester exposure leads to reduced Apgar scores 2 and low birth weight, as well as increased rates of premature birth and increased risk for admission to special care nurseries, 3 while other studies have not found similar outcomes. 4,5 Concern about these adverse outcomes led the US FDA 6 (US Food and Drug Administration) and Health Canada 7 to issue warnings in 2004 regarding late pregnancy use of SRIs. Compounding medication-related effects, adverse neonatal behaviors have also been observed following exposure to maternal depression alone 8 and therefore identifying SRI-related outcomes has been challenged by the difficulty of distinguishing medication effects from the effects of the maternal disease itself.…”

Section: Introductionmentioning

confidence: 99%

Infant serotonin transporter (SLC6A4) promoter genotype is associated with adverse neonatal outcomes after prenatal exposure to serotonin reuptake inhibitor medications

et al. 2007

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Reduced Apgar scores and birth weight, increased risk of respiratory distress, jitteriness and increased tone have been reported in up to 30% of neonates with prenatal exposure to serotonin reuptake inhibitor (SRI) antidepressant medications. In adults, effects of these medications may be related to the genotype for the serotonin transporter (SLC6A4) promoter. In this study we investigated whether SLC6A4 genotype influences the risk for adverse outcomes in neonates with prenatal SRI exposure. Neonatal outcomes including Apgar scores, birth weight, gestational age at birth, symptoms of poor neonatal adaptation and genotype for SLC6A4 were determined in 37 prenatally SRI exposed neonates and compared with 47 nonexposed neonates. Reduced 5 min Apgar scores were observed in exposed neonates and this was moderated by the ss genotype (P < 0.001). Birth weight was lower in exposed ls neonates (P = 0.008). Risk for respiratory symptoms (respiratory distress and rapid breathing) was higher in exposed neonates with the ll genotype compared to non-exposed neonates (P < 0.05) and risk for neuromotor symptoms increased in exposed ss neonates (P < 0.026). These relationships remained when controlling for maternal mood during pregnancy, length of gestational medication exposure and gestational age at birth and cesarean section rate. Prenatal SRI exposure was associated with adverse neonatal outcomes and these effects were moderated by infant SLC6A4 genotype. Relationships between polymorphisms and specific outcomes varied during the neonatal period, suggesting that beyond apparent gene-medication interactions, multiple mechanisms contribute to adverse neonatal outcomes following prenatal SRI exposure.

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Perinatal Outcome Following Third Trimester Exposure to Paroxetine

Abstract: When used near term, paroxetine is associated with a high rate of neonatal complications, possibly caused by its common discontinuation syndrome.

Cited by 238 publications

References 10 publications

Prenatal exposure to serotonin reuptake inhibitor antidepressants and childhood behavior

Prenatal exposure to serotonin reuptake inhibitor antidepressants and childhood behavior

Neonatal Antidepressant Exposure has Lasting Effects on Behavior and Serotonin Circuitry

Infant serotonin transporter (SLC6A4) promoter genotype is associated with adverse neonatal outcomes after prenatal exposure to serotonin reuptake inhibitor medications

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