In utero antidepressant exposure.(Drugs, Pregnancy, And Lactation)

Data on the risk of fetal malformations and adverse peripartum events associated with in utero exposure to antidepressants are reassuring, especially with regard to the tricyclics and some of the selective serotonin reuptake inhibitors. Prospective data on the longer-term neurobehavioral sequelae associated with such exposure are much more limited, however.

In the last several years, some studies have been published in which researchers tracked neurobehavioral function over a period of months to years in children exposed to SSRIs in utero. While it's exciting to have some new information in this previously uncharted area, some of the data are inconsistent and have led to confusion among patients and health care providers.

A recent study conducted by investigators at the Motherisk Program at the University of Toronto prospectively evaluated the neurodevelopment of 86 children aged 15-71 months who were exposed to fluoxetine (Prozac) or a tricyclic antidepressant throughout pregnancy.

The study showed no differences in well-established neurobehavioral indices between these children and 36 unexposed children of nondepressed women (Am. J. Psychiatry 159[11]:1889-95, 2002). This study was a follow-up to an earlier study that looked at neurobehavioral function in children exposed to these medications only during the first trimester, and the results were consistent.

Of note, the duration of maternal depression was a significant negative predictor of cognitive function in children; for example, the number of depressive episodes after delivery was negatively associated with language scores. These data support the now well-established finding that an uncontrolled postpartum mood disorder can have adverse effects on the baby's neurocognitive development.

In a study published in April, Stanford University investigators compared the perinatal and neurobehavioral outcomes of 31 children exposed in utero to fluoxetine, sertraline (Zoloft), fluvoxamine (Luvox), or paroxetine (Paxil), with those of 13 children whose mothers had a major depressive disorder and received psychotherapy but did not take medication during their pregnancies.

When evaluated between ages 6 months and 40 months, the SSRI-exposed children had significantly lower scores on psychomotor indices and on neurobehavioral ...