Serotonin reuptake inhibitor use in pregnancy and the neonatal behavioral syndrome

Objective. To assess the severity of neonatal behavioral syndrome (NBS) in infants of serotonin reuptake inhibitor (SRI)-treated pregnancies, compared with infants of women with psychiatric illness not treated with medication. Methods. This was a retrospective cohort study of pregnancies followed in a prenatal clinic for women with psychiatric illness. Infants of women who received SRI medication through delivery (SRI-treated) were compared with those who did not receive treatment or discontinued medication before the last month of pregnancy (SRI-untreated). NBS was defined as one or more of the following: jitteriness, irritability, lethargy, hypotonia, hypertonia, hyperreflexia, apnea, respiratory distress, vomiting, poor feeding, or hypoglycemia. Results. Findings of NBS were identified in 28% of 46 SRI-treated pregnancies and 17% of 59 untreated pregnancies. There were no differences in rates of prematurity (4% vs. 7%), fetal growth restriction (6% vs. 2%), transfer to a higher nursery for NBS (11% vs. 10%), respiratory abnormality (7% vs. 5%), or hospitalization duration among infants with NBS findings (2 vs. 6 days). Conclusions. Findings of NBS were identified in 28% of SRI-exposed neonates. However, these infants were not more likely than unexposed infants to be admitted to a higher nursery, experience respiratory abnormalities, or have prolonged hospitalization.