SSRIs, Benzodiazepines, and Early Postnatal Development

Deborah Cowley, MD reviewing Salisbury AL et al. Am J Psychiatry 2015 Oct 30.

Neonatal effects of maternal drug therapy persisted longer than 1 week and were not prevented by stopping medication during late pregnancy.

Neonatal adaptation syndrome (characterized by tremors, irritability, and respiratory distress) has been reported in up to 30% of newborns prenatally exposed to selective serotonin reuptake inhibitors (SSRIs). In a prospective cohort study involving 184 women (mean age, 28) and their healthy, singleton infants born at ≥37 weeks' gestation, investigators examined neurobehavioral development during the first postnatal month after in utero exposure to SSRIs (52 pregnancies), SSRIs plus benzodiazepines (10 pregnancies), untreated unipolar depression (56 pregnancies), or no psychiatric disorder (66 pregnancies). Infants were assessed on postnatal days 2, 4, 7, 14, and 30.

Compared with the no-exposure group, SSRI-exposed infants had lower quality of movement, more hypotonia, more stress-abstinence signs in the central nervous system (CNS), and higher arousal and lower self-regulation scores at day 14. All three clinical groups showed poorer habituation and attention at day 30. No differences were seen in infants with SSRI exposure through delivery versus those whose mothers discontinued SSRIs before the last month of pregnancy. Benzodiazepine exposure was associated with significantly higher rates of maternal comorbid anxiety disorders and, in newborns, the poorest movement quality and highest number of CNS stress-abstinence signs.

Citation(s):

Salisbury AL et al. The roles of maternal depression, serotonin reuptake inhibitor treatment, and concomitant benzodiazepine use on infant neurobehavioral functioning over the first postnatal month. Am J Psychiatry 2015 Oct 30; [e-pub].