This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (60)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Zeskind, P. S.
Right arrow Articles by Stephens, L. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Zeskind, P. S.
Right arrow Articles by Stephens, L. E.
Related Collections
Right arrow Premature & Newborn
PEDIATRICS Vol. 113 No. 2 February 2004, pp. 368-375

Maternal Selective Serotonin Reuptake Inhibitor Use During Pregnancy and Newborn Neurobehavior

Philip Sanford Zeskind, PhD*,{ddagger} and Laura E. Stephens*

* Department of Pediatrics, Carolinas Medical Center, Charlotte, North Carolina
{ddagger} Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina

Objective. This is a prospective study of the effects of maternal use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy on newborn neurobehavioral integrity, including systematic measures of behavioral state, sleep organization, motor activity, heart rate variability (HRV), tremulousness, and startles.

Methods. The sample included 17 SSRI-exposed and 17 nonexposed, full-birth-weight newborn infants who had no obvious medical problems and were matched on maternal cigarette use, social class, and maternal age. SSRI exposure was determined by medical records and maternal self-report during a standard interview. Behavioral state, startles, and tremulousness were evaluated for 1 hour between feedings. Automated recordings of motor activity and HRV were also assessed during a 15-minute subset sleep period. HRV was subjected to spectral analysis to detect rhythms in autonomic regulation. Exposed and nonexposed infant groups were compared on measures of neurobehavioral development both before and after adjustment for gestational age as a covariate.

Results. SSRI-exposed infants had a shorter mean gestational age; were more motorically active and tremulous; and showed fewer rhythms in HRV, fewer changes in behavioral state, fewer different behavioral states, and a lower peak behavioral state. SSRI-exposed infants also had significantly more rapid eye movement sleep, which was characterized by longer continuous bouts in that state and higher numbers of spontaneous startles or sudden arousals. After effects of gestational age were covaried, significant differences continued to be found in tremulousness and all measures of state and sleep organization, but effects on startles, motor activity, and rhythms in HRV were no longer significant.

Conclusions. Results provide the first systematic evidence that women who use SSRIs during pregnancy have healthy, full-birth-weight newborn infants who show disruptions in a wide range of neurobehavioral outcomes. Effects on motor activity, startles, and HRV may be mediated through the effects of SSRI exposure on gestational age. Future research can lead to a better understanding of the effects of SSRI use during pregnancy and an improved public health outcome.

Key Words: SSRI • pregnancy • neurobehavior • sleep • heart rate variability • maternal depression

Abbreviations: SSRI, selective serotonin reuptake inhibitor • HRV, heart rate variability • SES, socioeconomic status • NBAS, Neonatal Behavioral Assessment Scale • REM, rapid eye movement • CPM, cycles per minute • SE, standard error • IUGR, intrauterine growth retardation

Received for publication Sep 29, 2003; Accepted Oct 7, 2003.




This article has been cited by other articles:


Home page
 Am. J. PsychiatryHome page
R. Suri, L. Altshuler, G. Hellemann, V. K. Burt, A. Aquino, and J. Mintz
Effects of Antenatal Depression and Antidepressant Treatment on Gestational Age at Birth and Risk of Preterm Birth
Am J Psychiatry, August 1, 2007; 164(8): 1206 - 1213.
[Abstract] [Full Text] [PDF]

Home page
 JWatch Women's HealthHome page
Follow-Up on Antidepressants During Pregnancy: An Exchange of Views
Journal Watch Women's Health, July 12, 2007; 2007(712): 6 - 6.
[Full Text]

Home page
 Clinical Case StudiesHome page
R. T. Ammerman, A. L. Bodley, F. W. Putnam, W. L. Lopez, L. J. Holleb, J. Stevens, and J. B. Van Ginkel
In-Home Cognitive Behavior Therapy for a Depressed Mother in a Home Visitation Program
Clinical Case Studies, April 1, 2007; 6(2): 161 - 180.
[Abstract] [PDF]

Home page
 PediatricsHome page
E. Ferreira, A. M. Carceller, C. Agogue, B. Z. Martin, M. St-Andre, D. Francoeur, and A. Berard
Effects of Selective Serotonin Reuptake Inhibitors and Venlafaxine During Pregnancy in Term and Preterm Neonates
Pediatrics, January 1, 2007; 119(1): 52 - 59.
[Abstract] [Full Text] [PDF]

Home page
 Arch Gen PsychiatryHome page
T. F. Oberlander, W. Warburton, S. Misri, J. Aghajanian, and C. Hertzman
Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data.
Arch Gen Psychiatry, August 1, 2006; 63(8): 898 - 906.
[Abstract] [Full Text] [PDF]

Home page
 J PsychopharmacolHome page
C. L. Devane, Z. N. Stowe, J. L. Donovan, D. J. Newport, P. B. Pennell, J. C. Ritchie, M. J. Owens, and J.-S. Wang
Therapeutic drug monitoring of psychoactive drugs during pregnancy in the genomic era: challenges and opportunities.
J Psychopharmacol, July 1, 2006; 20(4 Suppl): 54 - 59.
[Abstract] [PDF]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
P Bot, B A Semmekrot, and J van der Stappen
Neonatal effects of exposure to selective serotonin reuptake inhibitors during pregnancy.
Arch. Dis. Child. Fetal Neonatal Ed., March 1, 2006; 91(2): F153 - F153.
[Full Text] [PDF]

Home page
 NEJMHome page
C. D. Chambers, S. Hernandez-Diaz, L. J. Van Marter, M. M. Werler, C. Louik, K. L. Jones, and A. A. Mitchell
Selective Serotonin-Reuptake Inhibitors and Risk of Persistent Pulmonary Hypertension of the Newborn
N. Engl. J. Med., February 9, 2006; 354(6): 579 - 587.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
L. S. Cohen, L. L. Altshuler, B. L. Harlow, R. Nonacs, D. J. Newport, A. C. Viguera, R. Suri, V. K. Burt, V. Hendrick, A. M. Reminick, et al.
Relapse of Major Depression During Pregnancy in Women Who Maintain or Discontinue Antidepressant Treatment
JAMA, February 1, 2006; 295(5): 499 - 507.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
R. Levinson-Castiel, P. Merlob, N. Linder, L. Sirota, and G. Klinger
Neonatal Abstinence Syndrome After In Utero Exposure to Selective Serotonin Reuptake Inhibitors in Term Infants
Arch Pediatr Adolesc Med, February 1, 2006; 160(2): 173 - 176.
[Abstract] [Full Text] [PDF]

Home page
 J PsychopharmacolHome page
P. M. Haddad, B. R. Pal, P. Clarke, A. Wieck, and S. Sridhiran
Neonatal symptoms following maternal paroxetine treatment: Serotonin toxicity or paroxetine discontinuation syndrome?
J Psychopharmacol, September 1, 2005; 19(5): 554 - 557.
[Abstract] [PDF]

Home page
 Reproductive SciencesHome page
J. L. Mornson, D. W. Rurak, C. Chien, D. J. Kennaway, N. Gruber, I. C. McMillen, and K. W. Riggs
Maternal Fluoxetine Infusion Does Not Alter Fetal Endocrine and Biophysical Circadian Rhythms in Pregnant Sheep
Reproductive Sciences, July 1, 2005; 12(5): 356 - 364.
[Abstract] [PDF]

Home page
 JAMAHome page
E. L. Moses-Kolko, D. Bogen, J. Perel, A. Bregar, K. Uhl, B. Levin, and K. L. Wisner
Neonatal Signs After Late In Utero Exposure to Serotonin Reuptake Inhibitors: Literature Review and Implications for Clinical Applications
JAMA, May 18, 2005; 293(19): 2372 - 2383.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
P. Vanhaesebrouck, F. De Bock, A. Zecic, C. De Praeter, K. Smets, K. De Coen, and L. Goossens
Phototherapy-Mediated Syndrome of Inappropriate Secretion of Antidiuretic Hormone in an In Utero Selective Serotonin Reuptake Inhibitor-Exposed Newborn Infant
Pediatrics, May 1, 2005; 115(5): e508 - e511.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
S. P. Kruszewski and D. M. Ferriero
Neonatal Brain Injury
N. Engl. J. Med., February 24, 2005; 352(8): 839 - 839.
[Full Text] [PDF]

Home page
 PediatricsHome page
T. F. Oberlander, R. E. Grunau, C. Fitzgerald, M. Papsdorf, D. Rurak, and W. Riggs
Pain Reactivity in 2-Month-Old Infants After Prenatal and Postnatal Selective Serotonin Reuptake Inhibitor Medication Exposure
Pediatrics, February 1, 2005; 115(2): 411 - 425.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
J. D. Norton, L. L. M. Worley, and C. L. Lowery
Findings From Selective Serotonin Reuptake Inhibitor-Exposed Neonates Should Be Interpreted With Caution
Pediatrics, December 1, 2004; 114(6): 1739 - 1740.
[Full Text] [PDF]

Home page
 ScienceHome page
M. S. Ansorge, M. Zhou, A. Lira, R. Hen, and J. A. Gingrich
Early-Life Blockade of the 5-HT Transporter Alters Emotional Behavior in Adult Mice
Science, October 29, 2004; 306(5697): 879 - 881.
[Abstract] [Full Text] [PDF]

Home page
 JWatch PsychiatryHome page
SSRIs in Pregnancy: Effects on the Newborn
Journal Watch Psychiatry, July 7, 2004; 2004(707): 8 - 8.
[Full Text]

Home page
 PediatricsHome page
E. Vavasour
Nutritional Implications of Observed Neurobehavioral Disturbances and Reduced Gestation Length in Infants of Mothers Using Selective Serotonin Reuptake Inhibitors During Pregnancy
Pediatrics, July 1, 2004; 114(1): 325 - 325.
[Full Text] [PDF]

Home page
 JWatch Women's HealthHome page
SSRIs in Pregnancy: Effects on the Newborn
Journal Watch Women's Health, April 20, 2004; 2004(420): 10 - 10.
[Full Text]