Treatment With Selective Serotonin Reuptake Inhibitors During Pregnancy: Deceleration of Weight Gain Because of Depression or Drug?

摘要

In 1996, Chambers and colleagues (1) reported that exposure to fluoxetine in the third trimester of pregnancy was associated with an increased risk of preterm birth, small-for-gestational-age infants, admission to special care nurseries, and poor neonatal adaptation, including respiratory difficulty, cyanosis on feeding, and jitteriness. This landmark article generated substantial concern among clini- cians that third-trimester exposure to fluoxetine (and potentially other selective serotonin reuptake inhibitors [SSRIs]) was contributing to adverse outcomes in pregnancy. Of interest, no adverse effects from first-trimester exposure were observed. The offspring of women who discontinued fluoxetine before 25 weeks' gestation had neonatal outcomes that were similar to those of comparison subjects. Similarly, in a study of maternity hospital discharge and pharmacy records, Simon et al. (2) reported that exposure to SSRIs was associated with a 0.9-week decrease in mean gestational age, a 175-g decrease in mean birth weight, and a 0.29 decrease in mean APGAR score 5 minutes after birth. The differences in birth weights and APGAR scores were not significant after adjustment for gestational age. Less favorable APGAR scores were limited to those with third-trimester exposure. Neither tricyclic antidepressant nor SSRI exposure was significantly associated with congenital malformations or developmental delay. There were no differences in infant outcome among tricyclic-exposed infants compared to unexposed newborns, which suggested a specific effect of the SSRI rather than maternal depression. In infants born to women treated with antidepres-sants throughout pregnancy, CNS, motor, respiratory, and gastrointestinal signs that are usually mild and subside by 2 weeks of age have been reported (3, 4). This neonatal behavioral syndrome resulted in the Food and Drug Administration's (FDA's) recommendation for inclusion of this risk in the labeling of these agents.