Antidepressant Drugs During Late Pregnancy Have Neonatal Effects

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Antidepressant Drugs During Late Pregnancy Have Neonatal Effects

Laurie Barclay, MD

April 5, 2004 - A prospective study reported in the April issue of the Archives

of Pediatric and Adolescent Medicine identified adverse birth outcomes for women

who used antidepressants late in pregnancy.

" Exposure to antidepressants during the third trimester of pregnancy has been

associated with an increased risk for adverse birth outcomes, including preterm

birth, respiratory distress, and hypoglycemia, " write Bengt Kallen, MD, PhD,

from the University of Lund in Sweden, and colleagues.

Based on prospectively recorded information in antenatal care documents of the

Swedish Medical Birth Registry, the investigators analyzed neonatal outcomes in

997 infants of 987 mothers after maternal use of antidepressants.

Compared with infants not exposed to antidepressants, those whose mothers used

antidepressants had nearly double the risk for preterm birth (odds ratio [OR],

1.96) and low birth weight (OR, 1.98). After exposure to tricyclic

antidepressants, the gestational week-specific birth weight was notably

increased. Other increased risks were for low Apgar score (OR, 2.33),

respiratory distress (OR, 2.21), neonatal convulsions (OR, 1.90), and

hypoglycemia (OR, 1.62). Risk of hypoglycemia was especially increased after

exposure to tricyclic drugs. However, the risk of neonatal jaundice was not

significantly increased (OR, 1.13).

Most of these adverse effects seemed not to be specific for selective serotonin

reuptake inhibitors (SSRIs). Outcomes after exposure to paroxetine were no worse

than after exposure to other SSRIs.

Study limitations include maternal use of other drugs, lack of data on the exact

time of administration of the drugs in about 40% of the cases, inability to

confirm that prescribed drugs were actually taken, and lack of detailed

information on the days of occurrence of neonatal convulsions or other possible

withdrawal symptoms.

" Certain anomalies can be found in the outcome after the use of antidepressant

drugs in late pregnancy, " the authors write. " To some extent, these may be the

result of the underlying disease or of factors associated with the disease, but

a direct drug [effect] is likely, at least partly as withdrawal symptoms. If

anything, outcome seemed more unfavorable after the use of tricyclic drugs than

after the use of SSRIs, which perhaps should be the drugs of choice during

pregnancy. "

The K.A. Wallenberg Foundation in Stockholm, Sweden, supported this study.

In an accompanying editorial, Gideon Koren, MD, FABMT, FRCPC, from The Hospital

for Sick Children in Toronto, Ontario, Canada, cites evidence that

antidepressants are not teratogenic in humans at recommended doses, and he notes

methodological and design flaws in this study.

" The adverse effects of untreated or suboptimally treated maternal depression,

both antenatally and postnatally, should be considered and should lead to

optimal treatment, not to abrupt discontinuation, " Dr. Koren writes.

Although phenobarbital is used most commonly for symptomatic management of

neonatal withdrawal, he suggests that pharmacologically " it would make more

sense to administer the same SSRI as the neonate was exposed to in utero and

taper it off gradually in the same fashion as neonatal opioid withdrawal.

However, this approach must be tested first in a well-designed study. "

Arch Pediatr Adolesc Med. 2004;158:312-316

Reviewed by D. Vogin, MD

Jim - Norman

" Never look at the trombones, it only encourages them. "

Strauss

[Guest guest]

Careful!! This has many technical words. Go to www.onelook.com to clear up any

words.

Antidepressant Drugs During Late Pregnancy Have Neonatal Effects

Laurie Barclay, MD

April 5, 2004 - A prospective study reported in the April issue of the Archives

of Pediatric and Adolescent Medicine identified adverse birth outcomes for women

who used antidepressants late in pregnancy.

" Exposure to antidepressants during the third trimester of pregnancy has been

associated with an increased risk for adverse birth outcomes, including preterm

birth, respiratory distress, and hypoglycemia, " write Bengt Kallen, MD, PhD,

from the University of Lund in Sweden, and colleagues.

Based on prospectively recorded information in antenatal care documents of the

Swedish Medical Birth Registry, the investigators analyzed neonatal outcomes in

997 infants of 987 mothers after maternal use of antidepressants.

Compared with infants not exposed to antidepressants, those whose mothers used

antidepressants had nearly double the risk for preterm birth (odds ratio [OR],

1.96) and low birth weight (OR, 1.98). After exposure to tricyclic

antidepressants, the gestational week-specific birth weight was notably

increased. Other increased risks were for low Apgar score (OR, 2.33),

respiratory distress (OR, 2.21), neonatal convulsions (OR, 1.90), and

hypoglycemia (OR, 1.62). Risk of hypoglycemia was especially increased after

exposure to tricyclic drugs. However, the risk of neonatal jaundice was not

significantly increased (OR, 1.13).

Most of these adverse effects seemed not to be specific for selective serotonin

reuptake inhibitors (SSRIs). Outcomes after exposure to paroxetine were no worse

than after exposure to other SSRIs.

Study limitations include maternal use of other drugs, lack of data on the exact

time of administration of the drugs in about 40% of the cases, inability to

confirm that prescribed drugs were actually taken, and lack of detailed

information on the days of occurrence of neonatal convulsions or other possible

withdrawal symptoms.

" Certain anomalies can be found in the outcome after the use of antidepressant

drugs in late pregnancy, " the authors write. " To some extent, these may be the

result of the underlying disease or of factors associated with the disease, but

a direct drug [effect] is likely, at least partly as withdrawal symptoms. If

anything, outcome seemed more unfavorable after the use of tricyclic drugs than

after the use of SSRIs, which perhaps should be the drugs of choice during

pregnancy. "

The K.A. Wallenberg Foundation in Stockholm, Sweden, supported this study.

In an accompanying editorial, Gideon Koren, MD, FABMT, FRCPC, from The Hospital

for Sick Children in Toronto, Ontario, Canada, cites evidence that

antidepressants are not teratogenic in humans at recommended doses, and he notes

methodological and design flaws in this study.

" The adverse effects of untreated or suboptimally treated maternal depression,

both antenatally and postnatally, should be considered and should lead to

optimal treatment, not to abrupt discontinuation, " Dr. Koren writes.

Although phenobarbital is used most commonly for symptomatic management of

neonatal withdrawal, he suggests that pharmacologically " it would make more

sense to administer the same SSRI as the neonate was exposed to in utero and

taper it off gradually in the same fashion as neonatal opioid withdrawal.

However, this approach must be tested first in a well-designed study. "

Arch Pediatr Adolesc Med. 2004;158:312-316

Reviewed by D. Vogin, MD

Jim - Norman

" Never look at the trombones, it only encourages them. "

Strauss

[Guest guest]

Careful!! This has many technical words. Go to www.onelook.com to clear up any

words.

Antidepressant Drugs During Late Pregnancy Have Neonatal Effects

Laurie Barclay, MD

April 5, 2004 - A prospective study reported in the April issue of the Archives

of Pediatric and Adolescent Medicine identified adverse birth outcomes for women

who used antidepressants late in pregnancy.

" Exposure to antidepressants during the third trimester of pregnancy has been

associated with an increased risk for adverse birth outcomes, including preterm

birth, respiratory distress, and hypoglycemia, " write Bengt Kallen, MD, PhD,

from the University of Lund in Sweden, and colleagues.

Based on prospectively recorded information in antenatal care documents of the

Swedish Medical Birth Registry, the investigators analyzed neonatal outcomes in

997 infants of 987 mothers after maternal use of antidepressants.

Compared with infants not exposed to antidepressants, those whose mothers used

antidepressants had nearly double the risk for preterm birth (odds ratio [OR],

1.96) and low birth weight (OR, 1.98). After exposure to tricyclic

antidepressants, the gestational week-specific birth weight was notably

increased. Other increased risks were for low Apgar score (OR, 2.33),

respiratory distress (OR, 2.21), neonatal convulsions (OR, 1.90), and

hypoglycemia (OR, 1.62). Risk of hypoglycemia was especially increased after

exposure to tricyclic drugs. However, the risk of neonatal jaundice was not

significantly increased (OR, 1.13).

Most of these adverse effects seemed not to be specific for selective serotonin

reuptake inhibitors (SSRIs). Outcomes after exposure to paroxetine were no worse

than after exposure to other SSRIs.

Study limitations include maternal use of other drugs, lack of data on the exact

time of administration of the drugs in about 40% of the cases, inability to

confirm that prescribed drugs were actually taken, and lack of detailed

information on the days of occurrence of neonatal convulsions or other possible

withdrawal symptoms.

" Certain anomalies can be found in the outcome after the use of antidepressant

drugs in late pregnancy, " the authors write. " To some extent, these may be the

result of the underlying disease or of factors associated with the disease, but

a direct drug [effect] is likely, at least partly as withdrawal symptoms. If

anything, outcome seemed more unfavorable after the use of tricyclic drugs than

after the use of SSRIs, which perhaps should be the drugs of choice during

pregnancy. "

The K.A. Wallenberg Foundation in Stockholm, Sweden, supported this study.

In an accompanying editorial, Gideon Koren, MD, FABMT, FRCPC, from The Hospital

for Sick Children in Toronto, Ontario, Canada, cites evidence that

antidepressants are not teratogenic in humans at recommended doses, and he notes

methodological and design flaws in this study.

" The adverse effects of untreated or suboptimally treated maternal depression,

both antenatally and postnatally, should be considered and should lead to

optimal treatment, not to abrupt discontinuation, " Dr. Koren writes.

Although phenobarbital is used most commonly for symptomatic management of

neonatal withdrawal, he suggests that pharmacologically " it would make more

sense to administer the same SSRI as the neonate was exposed to in utero and

taper it off gradually in the same fashion as neonatal opioid withdrawal.

However, this approach must be tested first in a well-designed study. "

Arch Pediatr Adolesc Med. 2004;158:312-316

Reviewed by D. Vogin, MD

Jim - Norman

" Never look at the trombones, it only encourages them. "

Strauss

[Guest guest]

Careful!! This has many technical words. Go to www.onelook.com to clear up any

words.

Antidepressant Drugs During Late Pregnancy Have Neonatal Effects

Laurie Barclay, MD

April 5, 2004 - A prospective study reported in the April issue of the Archives

of Pediatric and Adolescent Medicine identified adverse birth outcomes for women

who used antidepressants late in pregnancy.

" Exposure to antidepressants during the third trimester of pregnancy has been

associated with an increased risk for adverse birth outcomes, including preterm

birth, respiratory distress, and hypoglycemia, " write Bengt Kallen, MD, PhD,

from the University of Lund in Sweden, and colleagues.

Based on prospectively recorded information in antenatal care documents of the

Swedish Medical Birth Registry, the investigators analyzed neonatal outcomes in

997 infants of 987 mothers after maternal use of antidepressants.

Compared with infants not exposed to antidepressants, those whose mothers used

antidepressants had nearly double the risk for preterm birth (odds ratio [OR],

1.96) and low birth weight (OR, 1.98). After exposure to tricyclic

antidepressants, the gestational week-specific birth weight was notably

increased. Other increased risks were for low Apgar score (OR, 2.33),

respiratory distress (OR, 2.21), neonatal convulsions (OR, 1.90), and

hypoglycemia (OR, 1.62). Risk of hypoglycemia was especially increased after

exposure to tricyclic drugs. However, the risk of neonatal jaundice was not

significantly increased (OR, 1.13).

Most of these adverse effects seemed not to be specific for selective serotonin

reuptake inhibitors (SSRIs). Outcomes after exposure to paroxetine were no worse

than after exposure to other SSRIs.

Study limitations include maternal use of other drugs, lack of data on the exact

time of administration of the drugs in about 40% of the cases, inability to

confirm that prescribed drugs were actually taken, and lack of detailed

information on the days of occurrence of neonatal convulsions or other possible

withdrawal symptoms.

" Certain anomalies can be found in the outcome after the use of antidepressant

drugs in late pregnancy, " the authors write. " To some extent, these may be the

result of the underlying disease or of factors associated with the disease, but

a direct drug [effect] is likely, at least partly as withdrawal symptoms. If

anything, outcome seemed more unfavorable after the use of tricyclic drugs than

after the use of SSRIs, which perhaps should be the drugs of choice during

pregnancy. "

The K.A. Wallenberg Foundation in Stockholm, Sweden, supported this study.

In an accompanying editorial, Gideon Koren, MD, FABMT, FRCPC, from The Hospital

for Sick Children in Toronto, Ontario, Canada, cites evidence that

antidepressants are not teratogenic in humans at recommended doses, and he notes

methodological and design flaws in this study.

" The adverse effects of untreated or suboptimally treated maternal depression,

both antenatally and postnatally, should be considered and should lead to

optimal treatment, not to abrupt discontinuation, " Dr. Koren writes.

Although phenobarbital is used most commonly for symptomatic management of

neonatal withdrawal, he suggests that pharmacologically " it would make more

sense to administer the same SSRI as the neonate was exposed to in utero and

taper it off gradually in the same fashion as neonatal opioid withdrawal.

However, this approach must be tested first in a well-designed study. "

Arch Pediatr Adolesc Med. 2004;158:312-316

Reviewed by D. Vogin, MD

Jim - Norman

" Never look at the trombones, it only encourages them. "

Strauss