Selective serotonin reuptake inhibitors and pregnancy: A review of maternal, fetal and neonatal risks and benefits

Marchocki, Zbigniew; Russell, Nóirín; Donoghue, K O’

doi:10.1177/1753495x13495194

Cited by 11 publications

(12 citation statements)

References 43 publications

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“…All the antidepressants we tested are being used in clinical practice, including pregnant women. Of these, paroxetine is the drug most frequently associated with fetal toxicity, including increased risks of septal heart defects [ 70 ], cardiovascular malformations [ 21 ], and neonatal withdrawal symptoms [ 71 ]. Correspondingly, in this study, we identified paroxetine as the most potent inhibitor of placental uptake of 5-HT by both SERT and OCT3.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous epidemiological studies have indicated a link between the use of antidepressants in pregnancy and negative effects on fetal development and programming. These include, inter alia, autism spectrum disorder, schizophrenia, depression, attention-deficit/hyperactivity disorder [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ] disturbance of the hypothalamic-pituitary axis [ 5 , 18 ], preeclampsia [ 19 , 20 ], metabolic and cardiovascular diseases [ 21 ], and pulmonary hypertension [ 22 ]. Interestingly, male offspring have higher susceptibility to autism and developmental delays after exposure to SSRIs than female offspring, indicating that fetal sex influences risks for adverse effects of prenatal antidepressants [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Depression is a prevalent condition affecting up to 20% of pregnant women. Hence, more than 10% are prescribed antidepressant drugs, mainly serotonin reuptake inhibitors (SSRIs) and selective serotonin and noradrenaline reuptake inhibitors (SNRIs). We hypothesize that antidepressants disturb serotonin homeostasis in the fetoplacental unit by inhibiting serotonin transporter (SERT) and organic cation transporter 3 (OCT3) in the maternal- and fetal-facing placental membranes, respectively. Paroxetine, citalopram, fluoxetine, fluvoxamine, sertraline, and venlafaxine were tested in situ (rat term placenta perfusion) and ex vivo (uptake studies in membrane vesicles isolated from healthy human term placenta). All tested antidepressants significantly inhibited SERT- and OCT3-mediated serotonin uptake in a dose-dependent manner. Calculated half-maximal inhibitory concentrations (IC50) were in the range of therapeutic plasma concentrations. Using in vitro and in situ models, we further showed that the placental efflux transporters did not compromise mother-to-fetus transport of antidepressants. Collectively, we suggest that antidepressants have the potential to affect serotonin levels in the placenta or fetus when administered at therapeutic doses. Interestingly, the effect of antidepressants on serotonin homeostasis in rat placenta was sex dependent. As accurate fetal programming requires optimal serotonin levels in the fetoplacental unit throughout gestation, inhibition of SERT-/OCT3-mediated serotonin uptake may help explain the poor outcomes of antidepressant use in pregnancy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…The request for abortion in women with affective disorders is higher, especially in those taking fluoxetine and mood stabilizers (especially sodium valproate). Concerns are linked to the evidence of increased risk of fetal malformations and obstetric complications in women who take those medications during pregnancy, but clinical experience with women who are affected by epilepsy suggests that these consequences are rare and manageable with adequate antenatal planning[ 39 , 40 ].…”

Section: Psychopathological Determinants Of Ttopmentioning

confidence: 99%

Therapeutic termination of pregnancy and women’s mental health: Determinants and consequences

Giacomo¹,

Pessina²,

Santorelli³

et al. 2021

WJP

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The therapeutic termination of pregnancy (TToP) is an induced abortion following a diagnosis of medical necessity. TToP is applied to avoid the risk of substantial harm to the mother or in cases of fetal unviability. This type of induced abortion is provided after the second semester of gestation if fetal illness or the pregnancy cause physical danger or pathological mental distress to the mother. Socio-cultural and economic determinants could influence the desire for children and family planning in couples, as well as the use of effective contraception and the choice to perform an induced abortion. Also, pre-existing mental health problems could affect the decision between carrying on a problematic pregnancy or having TToP. Furthermore, the TToP is a reproductive event with an important traumatic burden, but also with an intrinsic therapeutic effect and it can produce different psychological and psychopathological effects on women and couples. The aim of this review is to evaluate what demographic, reproductive and psychopathological determinants are involved in the choice of undergoing a TToP in women. Also, we will examine both positive and negative consequences of this procedure on women’s mental health, underlying which factors are related to a worse outcome in order to provide the best clinical support to vulnerable groups.

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“…There has been extensive research on the possible physical effects of maternal SSRI usage on fetal development [10,11,13,14,25]. SSRI use has been associated with an increased risk of congenital malformations [16,26].…”

Section: Potential Impact Of Ssris During Pregnancy Vs Untreated Depressionmentioning

confidence: 99%

“…possibly causing pulmonary hypertension, poor neonatal adaptation syndrome, and delayed neurological development). [11,13,15]. Fear of possible adverse effects on the developing baby is one of the contributing factors for a woman's decision to discontinue her medication when planning to become or being pregnant [21,23,27,28].…”

Section: Potential Impact Of Ssris During Pregnancy Vs Untreated Depressionmentioning

confidence: 99%

Perinatal SSRI Antidepressant Use: The Ongoing Ethical Dilemma and Continued Need for Practice Recommendations

Simhi

2021

austinjwomenshealth

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There is conflicting information regarding the risks and consequences of fetal exposure to antidepressant medications, specifically SSRIs. Providing pregnant women with accurate information regarding the risks and benefits associated with antidepressants is a critical public health issue. Unfortunately, clinical practice guidelines vary and sometimes offer contradictory recommendations regarding pharmacological treatment during pregnancy, because not enough is known about the effects of antidepressant medication on the fetus. Not surprisingly, both pregnant women and healthcare providers such as psychiatrists, psychiatric mental health nurses, and physicians express feelings of conflict when considering prescribing/taking SSRI’s. Current guidelines also do not provide guidance on presenting adequate informed consent for this potential conflict. This paper explores the literature on fetal harms and maternal-fetal conflict that are associated with antidepressant medication used in pregnancy and discuss the need for enhanced collaborative care. It also offers specific recommendations for addressing the ethical challenges that arise when pregnant women are considering antidepressant treatment.

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Selective serotonin reuptake inhibitors and pregnancy: A review of maternal, fetal and neonatal risks and benefits

Cited by 11 publications

References 43 publications

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

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

Therapeutic termination of pregnancy and women’s mental health: Determinants and consequences

Perinatal SSRI Antidepressant Use: The Ongoing Ethical Dilemma and Continued Need for Practice Recommendations

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