Maternal treatment with selective serotonin reuptake inhibitors during pregnancy and delayed neonatal adaptation: a population-based cohort study

Marie-Coralie Cornet; Yvonne W Wu; Heather Forquer; Lyndsay A Avalos; Achyuth Sriram; Aaron W Scheffler; Thomas B Newman; Michael W Kuzniewicz

doi:10.1136/archdischild-2023-326049

Maternal treatment with selective serotonin reuptake inhibitors during pregnancy and delayed neonatal adaptation: a population-based cohort study

Arch Dis Child Fetal Neonatal Ed. 2024 Apr 18;109(3):294-300. doi: 10.1136/archdischild-2023-326049.

Authors

Marie-Coralie Cornet¹, Yvonne W Wu^{2

3}, Heather Forquer⁴, Lyndsay A Avalos⁴, Achyuth Sriram⁵, Aaron W Scheffler⁶, Thomas B Newman^{2

6}, Michael W Kuzniewicz^{2

4

5}

Affiliations

¹ Department of Pediatrics, University of California San Francisco, San Francisco, California, USA marie-coralie.cornet@ucsf.edu.
² Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
³ Department of Neurology, University of California San Francisco, San Francisco, California, USA.
⁴ Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
⁵ Department of Pediatrics, Kaiser Permanente Northern California, Oakland, California, USA.
⁶ Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA.

Abstract

Objective: Selective serotonin reuptake inhibitor (SSRI) use is common in pregnancy. It is associated with delayed neonatal adaptation. Most previous studies have not adjusted for the severity of maternal mental health disorders or examined the impact of SSRI type and dosage. We examined whether treatment with SSRIs in late pregnancy (after 20 weeks) is associated with delayed neonatal adaptation independent of maternal depression and anxiety.

Design, setting and patients: Retrospective population-based birth cohort of 280 090 term infants born at 15 Kaiser Permanente Northern California hospitals, 2011-2019. Individual-level pharmacy, maternal, pregnancy and neonatal data were obtained from electronic medical records.

Exposure: Dispensed maternal SSRI prescription after 20 weeks of pregnancy.

Main outcome measures: Delayed neonatal adaptation defined as a 5 min Apgar score ≤5, resuscitation at birth or admission to a neonatal intensive care unit for respiratory support. Secondary outcomes included each individual component of the primary outcome and more severe neonatal outcomes (pulmonary hypertension, hypoxic-ischaemic encephalopathy and seizures).

Results: 7573 (2.7%) infants were exposed to SSRIs in late pregnancy. Delayed neonatal adaptation occurred in 11.2% of exposed vs 4.4% of unexposed infants (relative risk 2.52 (95% CI 2.36 to 2.70)). After multivariable adjustment, there was an association between SSRI exposure and delayed neonatal adaptation (adjusted OR 2.14 (95% CI 1.96 to 2.32)). This association was dose dependent. Escitalopram and fluoxetine were associated with the highest risk of delayed neonatal adaptation.

Conclusions: Infants exposed to SSRIs have increased risks of delayed adaptation in a type and dose-dependent relationship, pointing toward a causal relationship.

Keywords: Epidemiology; Intensive Care Units, Neonatal; Mental health; Neonatology; Resuscitation.

MeSH terms

Cohort Studies
Female
Hospitalization
Humans
Infant
Infant, Newborn
Pregnancy
Pregnancy Complications* / drug therapy
Prenatal Exposure Delayed Effects* / chemically induced
Prenatal Exposure Delayed Effects* / epidemiology
Retrospective Studies
Selective Serotonin Reuptake Inhibitors / adverse effects

Substances

Selective Serotonin Reuptake Inhibitors

Abstract

MeSH terms

Substances

Grants and funding