• neonatal distress syndrome

    Yet Another Study Investigating SSRIs and Their Impact on Neonatal Outcomes

    In a recent retrospective cohort study, data collected from linked records from the Women's and Children's Health Network in South Australia were used to investigate neonatal outcomes in children exposed prenatally to selective serotonin reuptake inhibitors (SSRIs).  Women were included in this study if they gave birth to a singleton, live-born infant between September 2000 and December 2008 (n = 33,965).

    SSRIs and Adverse Pregnancy Outcomes: Why You Can’t Just Read the Abstract

    Over the past few years, there have been a large number of studies which have relied on large administrative databases to generate information on the reproductive safety of various medications.  One of the strengths of this type of approach is that it provides an opportunity to observe outcomes in a large number of subjects; however, there are certain, very important limitations.  A recent study published in the American Journal of Obstetrics and Gynecology helps to understand some of the challenges in interpreting the data generated from these studies.

    Should SSRIs Be Tapered Prior To Delivery?

    Increased muscle tone, jitteriness, sleep disturbance, irritability, feeding problems, mild respiratory distress and myoclonus have been reported as symptoms of a potential neonatal distress syndrome related to exposure to SSRIs in late pregnancy.  The average duration of symptoms reported is 48 hours.  It is estimated that between 25-30% of SSRI-exposed infants are at risk for this syndrome.  No treatment intervention is required.  Reassuringly, follow-up studies have shown that at 2, 4, 6, and 8 months SSRI-exposed infants are indistinguishable from control infants without known exposure.

    SSRIs in Pregnancy and Neonatal Distress Syndrome

    Most obstetricians are now familiar with the potential for what has become known as neonatal distress syndrome (or "adaptation" syndrome) following third trimester exposure to SSRIs.  Some patients still worry about the possibility of their baby developing neonatal distress syndrome, especially if anything unusual happened during the post-delivery experience of an earlier pregnancy.  Women may be concerned about whether and to what degree the medication they were on played a role in their infant's distress and whether to continue that medication during a subsequent pregnancy.  The following case may help illustrate the decision-making dilemmas.

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