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Maternal use of SSRIs, SNRIs and NaSSAs: practical recommendations during pregnancy and lactation
  1. S D Sie1,
  2. J M B Wennink2,
  3. J J van Driel2,3,
  4. A G W te Winkel4,
  5. K Boer5,
  6. G Casteelen6,
  7. M M van Weissenbruch1
  1. 1Department of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
  2. 2St. Lucas Andreas Hospital, Amsterdam, The Netherlands
  3. 3Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
  4. 4Teratology Information Service, Netherlands Pharmacovigilance Centre, ‘s-Hertogenbosch, The Netherlands
  5. 5Department of Obstetrics & Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
  6. 6Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
  1. Correspondence to S D Sie, Department of Neonatology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands; s.sie{at}vumc.nl

Abstract

Selective serotonin reuptake inhibitors (SSRIs) are increasingly used during pregnancy and lactation, with 1.8–2.8% exposed pregnancies. Given the risks of untreated maternal depression for both mother and child, adequate treatment is essential. If pharmacological treatment with SSRIs is indicated, the fetal and neonatal effects of SSRIs have to be considered, as SSRIs cross the placenta and are excreted into breast milk. The overall risk of major congenital malformations during SSRI exposure in the first trimester does not appear to be greatly increased. Depending on the variability in pharmacokinetic properties between the different SSRIs and the individual drug metabolism of mother and child, SSRI exposure during late pregnancy can lead to serotonin reuptake inhibitor-related symptoms in up to 30% of exposed infants postnatally. Symptoms are generally mild and self-limited, but need observation during at least 48 h as some infants develop severe symptoms needing intervention. Limited data are available about the long-term neurodevelopmental outcomes after SSRI exposure during pregnancy and lactation, but currently, cognitive development seems normal, while behavioural abnormalities may be increased.

In this article, the available clinical data are reviewed. Additionally, the authors provide a multidisciplinary guideline for the monitoring and management of neonates exposed to SSRIs during pregnancy and lactation.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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