Mom on Antidepressants during pregnancy

Specialties Ob/Gyn

Published

Hello,

I'm new to the forum, but i've enjoyed reading lots of the old posts. I'm gathering as much information as I can. I'd like some feedback on an issue i've been wondering about. I've heard of serious incidents on maternal infant unit with infants who's mom was on antidepressants during pregnany. Just wondering if anyone has experienced issues with newborn distress and antidepressants and also, do you routinely use abstinence scoring for these infants. I've heard of other cases of infants having difficulties, so i'm wondering if we should routinely be doing this.

Thanks, looking forward to your feedback

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Specializes in Nurse Manager, Labor and Delivery.

I guess it would depend on the class of antidepressant you are talking about. In any case, it seems that everyone is on an antidepressant, but I mostly see zoloft. We do not use abstinence scoring for these kids. In my travels I haven't seen any difficulties related to the use. Would be interesting to hear if anyone else has.

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Specializes in NICU, PICU, educator.

I know that with Zoloft, once you hit 100mg/day, it starts causing problems with the baby and can cause resp. depression at birth. No one should be on Paxil as this has the greatest withdrawl and can send the baby into seizures. Paxil use in the 1st trimester also has an increased risk of congenital heart problems, with VSD being the most common. Prozac and Serafem shouldn't be used at greater than 40mg as it is toxic.

SSRI use in pregnancy, in studies, has shown that during the 3rd trimester there is a decreased umbilical artery flow as this class of drugs increases serotonin, which is a vasoconstrictor. There is also a risk of PPHN when exposed to SSRI's at and after 20 weeks (we have seen this in our unit).

In one study there was a need for NAS scoring for kids with exposure to SSRIs. The max scores were 48 hours after birth and some severe symptoms up to 4 days. I think it is 30% of kids exposed to an SSRI develop withdrawl symptoms.

The American Psychiatric Society recommends considering tapering SSRIs 10-14 days before the EDC. If you have a severely depressed woman, they can use ECT as this isn't harmful to the fetus.

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good info thanks

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Can the use of these meds (especially Prozac) decrease BTB variability? I think I have read that somewhere and I recently had a pt on Prozac with a non reactive strip for many hours deliver a vigorous baby. It was a lousy strip, doc wasn't worried. I was sure kid would be depressed at birth, but did fine.

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Yes, we have had neonates who needed transfer to tertiary care due to seizures from SSRIs taken by moms. What I can not accept is that these drugs can be prescribed by nurse-midwives !!! That is so wrong.........so out of their scope........but that could be another thread.

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Yeah its been on my mind. Since I began working serveral months ago, we have had two newborns in distress on our mother baby unit and needed transfer to NICU. I have learned to watch these infants VERY closely, and do abstinence scores as well. One of our Pedi's is pushing for this to be mandatory because he's seeing so many problems......scary stuff from SSRI's. 40 mgs of citalpram right up until delivery just seems to be a recipie for trouble....

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