Neonatal Effects after Selective Serotonin Reuptake Inhibitors and Benzodiazepines Administration during Pregnancy
Georgios Eleftheriou *
Poison Control Center and Teratology lnformation Service, Papa Giovanni XXIII Hospital, Piazza OMS 1, Bergamo, Italy.
Fiocchi Roberto
Cardiovascular Unit, Papa Giovanni XXIII Hospital, Italy.
Butera Raffaella
Poison Control Center and Teratology lnformation Service, Papa Giovanni XXIII Hospital, Italy.
Giampreti Andrea
Poison Control Center and Teratology lnformation Service, Papa Giovanni XXIII Hospital, Italy.
Mangili Giovanna
Unit of Neonatology, Papa Giovanni XXIII Hospital, Italy.
Molinaro Delfina
Clinical and Experimental Pharmacokinetics Unit, Foundation IRCCS Policlinico San Matteo, Pavia, Italy.
*Author to whom correspondence should be addressed.
Abstract
Aims: To evaluate whether the co-administration of benzodiazepines (BDZ) and selective serotonin and serotonin/norepinephrine reuptake inhibitors (SSRI/SNRI) during pregnancy is associated with an increased risk of abstinence symptoms in the newborns.
Methods: Twenty six neonates exposed in utero to SSRI/SNRI were studied. The presence of symptoms possibly due to neonatal abstinence syndrome, BDZ exposure, weight, age at birth and duration of hospitalization were recorded. Blood levels of SSRI/SNRI and BDZ were measured in all neonates.
Results: Neonatal blood levels of SSRI/SNRI were within or below normal adult therapeutic range in 21 newborns (81%). Thirteen newborns (50%) were symptomatic. Neonates born from mothers receiving co-administration of SSRI/SNRI and BDZ had a higher risk of developing symptoms as compared to those whose mother was not receiving BDZ (9/13, 69% versus 4/13, 31%, p ≤ 0.05). At birth, symptomatic newborns displayed a significatively lower weight and gestational age than asymptomatic neonates (2609 ± 301 vs 3112 ± 310 g, and 36 ± 1 vs 39 ± 1 week, respectively, p < 0.001). No relationship was found between symptoms and neonatal blood levels of either SSRI/SNRI or BDZ.
Conclusions: Our results suggest that the co-administration of SSRI/SNRI and benzodiazepines during pregnancy may be associated with an increased risk of neonatal symptoms. However, these symptoms are not related to blood levels and may be attributed to prematurity leading to a longer hospital stay.
Keywords: Neonatal abstinence syndrome, serotonin toxicity, selective serotonin reuptake inhibitors, benzodiazepines