RESEARCH - Antidepressant use during pregnancy appears associated with withdrawal symptoms in newborns

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Antidepressant Use During Pregnancy Appears Associated with Withdrawal

Symptoms in Newborns

CHICAGO, IL -- February 16, 2006 --Almost one-third of 60 newborn infants

whose mothers took antidepressants during pregnancy experienced neonatal

abstinence syndrome, a type of withdrawal with symptoms that include

high-pitched crying, tremors and disturbed sleep, according to a study in

the February issue of Archives of Pediatrics & Adolescent Medicine, one of

the JAMA/Archives journals.

Between one-tenth and one-fourth of women will develop depression in their

lifetimes, according to background information in the article. The stress of

pregnancy can worsen the condition and increase the need for medications.

Selective serotonin reuptake inhibitors (SSRIs) are a commonly used class of

antidepressants; they are known to cross the placenta, prompting research

into their effects on infants.

Levinson-Castiel, MD, of the Children's Medical Center of Israel,

Petah Tiqwa, and colleagues examined 120 babies born between Jan. 1, 2002,

and Aug. 31, 2004, at Rabin Medical Center in Israel. Sixty of the infants'

mothers took SSRIs for prolonged periods of time, including during the third

trimester. These infants and 60 control infants without exposure to SSRIs

were assessed two hours after birth and again at regular intervals if they

displayed withdrawal symptoms.

Of the 60 infants with exposure to SSRIs, 18 (30%) had neonatal abstinence

syndrome and eight of those cases were severe. The most common symptoms were

tremor, gastrointestinal problems, an abnormal increase in muscle tone

(hypertonicity), sleep disturbances and high-pitched cries. None of the

infants with symptoms required treatment, and none of the 60 infants without

exposure to SSRIs developed the syndrome.

" The high prevalence of neonatal abstinence syndrome in infants exposed to

SSRIs in utero should be brought to the attention of family physicians,

psychiatrists, gynecologists, pediatricians and mothers, " the authors write.

" Because maternal depression during pregnancy also entails a risk to the

newborn, the risk-benefit ratio of continuing SSRI treatment should be

assessed. " If a mother and physician decide medication is necessary, she

should be prescribed the minimum dose and number of drugs that would be

effective for her condition.

In addition, the authors conclude, the infants of mothers taking SSRIs

should be monitored closely after birth for a minimum of 48 hours " Follow-up

of exposed infants, particularly those who develop severe symptoms, is

needed to assess the long-term effects of prolonged exposure to SSRIs. "

Arch Pediatr Adolesc Med. 2006;160:173-176.

SOURCE: American Medical Association

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