From the Guidelines
Maternal SSRI use during pregnancy can potentially affect newborns, and it is crucial to weigh the benefits of treating maternal depression against potential risks to the newborn. The effects of maternal SSRI use on newborns can include neonatal adaptation syndrome, which typically appears within 48 hours after birth and includes symptoms such as irritability, poor feeding, respiratory distress, tremors, and occasionally seizures, as reported in a study published in Pediatrics 1. These symptoms are usually mild and resolve within 2-14 days without treatment. Some studies have suggested that specific SSRIs like fluoxetine, paroxetine, and sertraline have been associated with varying degrees of these effects, with paroxetine potentially carrying higher risks, although the evidence is not conclusive 1. Key considerations for clinicians include:
- Being aware that infants are at risk for manifesting clinical signs of drug toxicity or withdrawal over the first week of life
- Arranging for early follow-up after the initial hospital discharge to monitor for potential effects
- Counseling mothers on treatment with an SSRI who desire to nurse their infant about the risks and benefits, as the ratio of infant to maternal plasma concentrations can vary among different SSRIs 1. Despite these potential effects, abruptly stopping antidepressants during pregnancy is not recommended as untreated maternal depression poses significant risks to both mother and baby. The decision regarding SSRI use during pregnancy should involve weighing the benefits of treating maternal depression against potential risks to the newborn, ideally through consultation with both psychiatric and obstetric providers, as suggested by the American Academy of Pediatrics 1. Most experts agree that the benefits of treating significant maternal depression often outweigh the typically temporary and manageable risks to newborns.
From the FDA Drug Label
Neonates exposed to sertraline and other SSRIs or serotonin and norepinephrine reuptake inhibitors (SNRIs), late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. Such complications can arise immediately upon delivery Reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying. Infants exposed to SSRIs in pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn (PPHN). Neonates exposed to Prozac and other SSRIs or serotonin and norepinephrine reuptake inhibitors (SNRIs), late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. Infants exposed to SSRIs in late pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn (PPHN)
The effects on newborns due to maternal SSRI use include:
- Respiratory complications: requiring prolonged hospitalization, respiratory support, and tube feeding
- Neonatal abstinence syndrome: characterized by symptoms such as respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying
- Increased risk of persistent pulmonary hypertension of the newborn (PPHN): a potentially life-threatening condition associated with substantial neonatal morbidity and mortality 2 3
From the Research
Effects of Maternal SSRI Use on Newborns
- Maternal SSRI use during pregnancy has been associated with various risks to the newborn, including:
- Birth defects, specifically cardiac defects 4, 5
- Neonatal complications, such as premature delivery, low birth weight, and persistent pulmonary hypertension of the newborn 4, 5
- Neurodevelopmental disorders in childhood, including autism spectrum disorders 4
- Neonatal abstinence syndrome (NAS), characterized by symptoms such as depression, excitation, gastrointestinal issues, and respiratory problems 6
- The risk of these adverse outcomes is generally considered to be small, but may still be of concern to some patients 4, 7
- Untreated maternal depression also carries serious risks for both the mother and the baby, and SSRIs are one of the best available treatments 4, 5, 8
Risk-Benefit Assessment
- The decision to use SSRIs during pregnancy should be made after careful consideration of the potential risks and benefits 4, 7, 8
- Clinicians should weigh the use of SSRIs against the risk of untreated depressive disorder, taking into account the individual patient's circumstances and medical history 4, 7, 8
- Pregnant women exposed to SSRIs in early pregnancy may be offered options for prenatal diagnosis, such as ultrasound examinations and fetal echocardiography, to detect potential birth defects 4