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Subject:
From:
Judy Ritchie <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 22 Oct 2003 03:33:12 -0700
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In case this was not posted in July.
Judy Ritchie

http://www.medscape.com/viewarticle/458559

MEDSCAPE
Use of SSRIs During Pregnancy May Cause Neurologic Symptoms in Newborns
Laurie Barclay, MD
July 14, 2003 - Newborns of mothers receiving fluoxetine or citalopram
exhibited symptoms of central serotonin overstimulation for about four
days, according to the results of a prospective trial published in the
July issue of the Archives of General Psychiatry. The investigators warn
of potential neurologic adverse effects from selective serotonin
reuptake inhibitors (SSRIs) used during late pregnancy.
"SSRIs have gained wide acceptance in the treatment of mental disorders
in pregnant women, but there seems to be an increased risk for neonatal
adaptation problems after exposure to SSRIs in late pregnancy," write
Kari Laine, MD, PhD, from the University of Turku in Finland, and
colleagues. They cite previous studies suggesting that exposure to SSRIs
during the third trimester may cause irritability, constant crying,
eating and sleeping difficulties, and even seizures in newborns.
Between January 1, 1997, and August 31, 2000, Dr. Laine's group enrolled
40 pregnant women, including 20 who were taking SSRIs during pregnancy
and breast-feeding and 20 who were not taking any psychoactive
medications. All infants had neurologic assessments during the first
four days of life and at two weeks and two months of age after delivery,
as well as brain ultrasound and magnetic resonance imaging (MRI) 38 to
42 weeks after conception and at two months of age. During the first two
months of life, blood pressure, heart rate, and body temperature were
similar in both groups. During the first four days of life, the
serotonergic symptom score reflecting tremor, restlessness, and rigidity
was four times higher in the SSRI group than in the control group (P =
.008). Serotonin-related symptoms declined significantly in the SSRI
group from the first four days to two weeks, and there was no
significant difference in serotonergic symptom score between the two
groups at two weeks.
Cord blood concentration of 5-hydroxyindoleacetic acid (5-HIAA) was
significantly lower in the SSRI group than in the control group (P =
.02). Umbilical vein 5-HIAA concentration was inversely correlated with
serotonergic symptom score in the SSRI group (r = -0.66; P = .007) but
not in the control group.
Because the symptoms resolved quickly while SSRI concentrations were
decreasing, the authors suggest that the symptoms are related to central
nervous system serotonergic overstimulation rather than to SSRI
withdrawal syndrome.
"We report increased risk for central nervous system serotonergic
adverse effects during the first days of life in newborns of mothers
taking the SSRIs citalopram or fluoxetine during the third trimester of
pregnancy," they write. "The clinical relevance of the present results
is awareness of the psychiatrists who prescribe SSRIs during pregnancy
and the pediatricians who treat the serotonin-related neurologic
symptoms of the newborns during the first days of life. Although these
effects seem to subside quickly, they may expose the infants to more
serious neonatal complications such as convulsions."
The Turku University Hospital Research Fund supported this study. Arch
Gen Psychiatry. 2003;60:720-726 Reviewed by Gary D. Vogin, MD

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