SSRI in pregnancy and Infant Outcomes

Question 1

What are the complications of depression in pregnancy?

Answer 1

Biggest: suicide

Higher risk of miscarriage, preterm birth, low BW, respiratory distress, increased length of hospital stay.

Maternal child bonding
Cognitive, emotional, behavioural outcomes of kids

Question 2

What is the baseline risk of congenital malformations in the general population?

Answer 2

1-3%

Question 3

Does first trimester exposure to SSRIs increase the risk of major malformation?

Answer 3

Unclear

There was a meta-analysis in 2005 that said no.

In 2005 there was a large data-set that questioned an association with cardiac anomalies. There were further evaluations on paroxetine and its association with cardiac defects. Ultimately after much backwards and forwards it remains unclear if there is an association.

Question 4

If the data is unclear, regarding SSRIs and congenital malformations, how do we counsel families regarding the association with congenital malformations?

Answer 4

Paroxetine may be associated with a small increased risk of cardiac malformations

There may be an increased risk with specific malformations such as omphaloceles and craniosynostosis

Question 5

What is SSRI neonatal behaviour syndrome?

SNBS

Answer 5

Occurs when neonate a have been exposed to SSRIs in utero.

It is unclear if it occurs secondary to withdrawal or serotonin toxicity.

Question 6

How common is SNBS?

Answer 6

10-30% of fetuses exposed to SSRIs will have it.

Question 7

What is the timing of onset and resolution of SNBS?

Answer 7

Onset within hours

Resolution by 2 weeks

Question 8

What are the symptoms of SNBS?

Answer 8

GI: feeding disturbance
RESP: tachypnea, cyanosis ? PPHN
CNS: jittery, hypertonia, rarely seizures

Low birth weight
Admission to NICU
Lower gestational age

Most are mild and self-resolving. 10% are severe.

Question 9

Is there a trimester that is worse for causing SNBS?

Answer 9

Late gestation exposure to paroxetine and fluoxetine are the worst.

Question 10

Does exposure to SSRIs cause PPHN?

Answer 10

Unclear. Maybe.

12/377 neonates with PPHN had late gestation exposure to SSRIs
It is unclear if this is a coincidence of a rare association of fetal exposure to SSRIs and respiratory problems.

Question 11

Can women on SSRIS breast feed?

Answer 11

Yes.

SSRIs are excreted In Breast milk although there is no evidence of adverse effects on neonate.

Question 12

How many women develop depression in pregnancy?

Answer 12

8-20%