Selective serotonin reuptake inhibitors in pregnancy and infant outcomes

Question 1

What are examples of SSRI?

Answer 1

fluoxetine, paroxetine, sertraline, citalopram, fluvoxamine and escitalopram

Question 2

What percentage of women were prescribed SRI during pregnancy 2004-2005?

Answer 2

7%

Question 3

What is the risk of major malformations in infants exposed to SSRI in utero?

Answer 3

No increased risk

Question 4

What might in utero exposure to paroxetine in the first triemester by associated with?

Answer 4

Cardiac malformation (association evidence remains contradictory)

Question 5

What is SRI neonatal behavioural syndrome?

Answer 5

A syndrome of respiratory, motor, central nervous system and gastrointestinal symptoms, including tachypnea, cyanosis, jitteriness/tremors, increased muscle tone, and feeding disturbance has been noted in 10% to 30% of babies exposed to SSRIs in utero. Signs and symptoms usually present within hours, are typically mild, and usually resolve within two weeks. Seizures are reported rarely.

Question 6

What might fetal exposure to SSRI be associated with?

Answer 6

Absolute risk for persistent pulmonary hypertension is negligble

Question 7

What are the CPS recommendations?

Answer 7

1. Adequate treatment of depression in pregnancy is very important for the health and well-being of both mother and baby. An individual risk-benefit decision must be made concerning SSRI use in pregnancy, bearing in mind the following:
   a) SSRI neonatal behavioural syndrome is common but usually mild and transient,
   b) The absolute risk for persistent pulmonary hypertension is negligible,
   c) There is no evidence that SSRIs as a group increase the risk of congenital malformation, and
   d) The evidence for association of paroxetine and cardiac malformations remains contradictory
2. When women who are taking paroxetine are pregnant or contemplating pregnancy, their care providers may wish to consider switching them to another antidepressant or reducing the dose.
3. Babies with late-trimester SSRI exposure should be observed in hospital for neurobehavioural or respiratory symptoms for a minimum of 48 h. Families should receive anticipatory guidance on the possible effects of SSRIs on their infant, including the need
   for observation after birth.
4. Postpartum use of SSRIs is not a contraindication to breastfeeding, and women who choose to breastfeed should be supported