What is the timing of respiratory issues in newborns when the mother is on Selective Serotonin Reuptake Inhibitors (SSRI)?

From the Guidelines

Newborns whose mothers took SSRIs during pregnancy typically develop respiratory issues within several hours to several days after birth, with the onset of these signs ranging from several hours to several days after birth and usually resolving within 1 to 2 weeks.

Key Points

• The respiratory issues associated with SSRI exposure in newborns can include tachypnea or respiratory distress, among other symptoms 1.
• The risk of these complications is highest with SSRIs taken in the third trimester, particularly with medications like paroxetine, fluoxetine, and sertraline, although the exact timing and severity can vary 1.
• The respiratory symptoms generally resolve within 1 to 2 weeks but may require supportive care including oxygen supplementation, continuous positive airway pressure (CPAP), or rarely mechanical ventilation.
• These complications occur because SSRIs cross the placenta and affect serotonin regulation in the developing fetus, potentially altering pulmonary vascular tone and respiratory control mechanisms 1.

Management

• Healthcare providers should monitor all SSRI-exposed newborns for at least the first week of life, with particular attention to respiratory rate, effort, and oxygen saturation 1.
• Close coordination between obstetric and pediatric teams is essential for optimal management, balancing the benefits of maternal SSRI treatment with the temporary risks to the newborn 1.
• The benefits of maternal SSRI treatment often outweigh these temporary risks, but careful consideration and monitoring are necessary to ensure the best outcomes for both mother and child.

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 Neonates exposed to PAXIL 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

Respiratory issues in newborns when the mother is on SSRI can arise immediately upon delivery. Key points:

• Respiratory distress is a possible complication
• Immediately upon delivery is when these complications can arise
• The clinical significance of these effects is unknown 2
• Infants exposed to SSRIs in late pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn (PPHN) 3

From the Research

Timing of Respiratory Issues in Newborns

When the mother is on SSRI, the timing of respiratory issues in newborns can be related to the use of these medications during pregnancy.

• The studies suggest that maternal SSRI treatment during the third trimester has been linked to various neonatal complications, including symptoms of neonatal withdrawal and toxicity, prematurity, low birth weight, and persistent pulmonary hypertension of the newborn 4, 5.
• SSRI exposure during late pregnancy can lead to serotonin reuptake inhibitor-related symptoms in up to 30% of exposed infants postnatally, with symptoms generally mild and self-limited, but needing observation during at least 48 h as some infants develop severe symptoms needing intervention 6.
• There is an increased prevalence of septal heart defects among children whose mothers were prescribed an SSRI in early pregnancy, particularly sertraline and citalopram, and the largest association was found for children of women who redeemed prescriptions for more than one type of SSRI 7.
• Sertraline was associated with septal defects, atrial septal defects, and respiratory system defects, suggesting a potential risk of congenital malformations, including respiratory issues, in newborns exposed to SSRIs in utero 8.

Respiratory Issues in Newborns

Respiratory issues in newborns, such as persistent pulmonary hypertension of the newborn, can occur when the mother is on SSRI during pregnancy.

• The exact timing of these issues can vary, but they are often associated with third-trimester exposure to SSRIs 4, 5.
• The risk of respiratory system defects was found to be increased with sertraline exposure, with a relative risk of 2.65 (95% CI 1.32 to 5.32) 8.
• It is essential to monitor newborns exposed to SSRIs during pregnancy for at least 48 h after birth, as some may develop severe symptoms needing intervention 6.