Archives of Women's Mental Health

, Volume 22, Issue 6, pp 791–797 | Cite as

The effect of maternal antidepressants on third trimester uteroplacental hemodynamics and the neonatal abstinence syndrome: a retrospective cohort study

  • Katherine McLean
  • Kellie E. Murphy
  • Ariel Dalfen
  • Alison K. SheaEmail author
Original Article


The objective of this study is to determine whether maternal antidepressant use during pregnancy influences uteroplacental hemodynamics, thereby affecting fetal growth and gestational age at delivery. The secondary aim was to determine the incidence of neonatal abstinence syndrome (NAS) among infants exposed to antidepressant medications. The charts of women who received obstetrical care and had a history of depression from January 2014 to December 2016 at Mount Sinai Hospital in Toronto, Canada, were reviewed. Exclusion criteria were substance abuse; narcotic or lithium use at the time of delivery.

In total, 205 women met the inclusion criteria (92 took antidepressants; 113 women did not). There were no significant differences in umbilical artery pulsatility index (PI), gestational age at delivery, or birth weight when comparing women based on antidepressant use. A small proportion (18%) of neonates had mild withdrawal symptoms; one baby had a score (≥ 8) consistent with severe NAS. In women with a history of depression, there was no difference in uteroplacental hemodynamics as measured by third trimester Doppler ultrasonography when comparing women who took antidepressant medication versus those who did not. The large majority of babies who were exposed to antidepressants in utero did not show withdrawal symptoms. These results lend support for the relative safety of antidepressants during pregnancy.


SSRI Antidepressant Pregnancy Depression Birth outcome Doppler Growth 


Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Mount Sinai Hospital Research Ethics Board (MSH REB no. 14-0207-C). As this was a retrospective chart review study, informed consent was not required.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR (2004) Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 103:698–709CrossRefGoogle Scholar
  2. Charlton RA, Jordan S, Pierini A, Garne E, Neville AJ, Hansen AV, Gini R, Thayer D, Tingay K, Puccini A, Bos HJ, Nybo Andersen AM, Sinclair M, Dolk H, de Jong-van den Berg L (2015) Selective serotonin reuptake inhibitor prescribing before, during and after pregnancy: a population-based study in six European regions. BJOG 122:1010–1020CrossRefGoogle Scholar
  3. Dubber S, Reck C, Muller M, Gawlik S (2015) Postpartum bonding: the role of perinatal depression, anxiety and maternal-fetal bonding during pregnancy. Arch Womens Ment Health. 18(2):187–195CrossRefGoogle Scholar
  4. Eke AC, Saccone G, Berghella V (2016) Selective serotonin reuptake inhibitor (SSRI) use during pregnancy and risk of preterm birth: a systematic review and meta-analysis. BJOG 123:1900–1907CrossRefGoogle Scholar
  5. Finnegan LP (1990) Neonatal abstinence. In: Nelson NM (ed) Current therapy in neonatal–perinatal medicine, 2nd edn. BC Decker Inc, Toronto, OntarioGoogle Scholar
  6. Forsberg L, Navér L, Gustafsson LL, Wide K. Neonatal adaptation in infants prenatally exposed to antidepressants—clinical monitoring using neonatal abstinence score. PLoS 2014; ONE9(11): e111327, 9CrossRefGoogle Scholar
  7. Grigoriadis S, Wilton AS, Kurdyak PA, Rhodes AE, VonderPorten EH, Levitt A, Cheung A, Vigod SN (2017) Perinatal suicide in Ontario, Canada: a 15-year population-based study. CMAJ 189(34):E1085–E1092CrossRefGoogle Scholar
  8. Harville EW, Savitz DA, Dole N, Herring AH, Thorp JM, Light KC (2008) Stress and placental resistance measured by Doppler ultrasound in early and mid-pregnancy. Ultrasound Obstet Gynecol 32:23–30CrossRefGoogle Scholar
  9. Huybrechts KF, Bateman BT, Desai RJ, Hernandez-Diaz S, Rough K, Mongun H et al (2017) Risk of neonatal drug withdrawal after intrauterine co-exposure to opiods and psychotropic medications: cohort study. BMJ 358:j3326CrossRefGoogle Scholar
  10. Jarde A, morais M, Kingston D, Giallo R et al (2016) Does non-pharmacological therapy for antenatal depression reduce risks for the infant? Arch Womens Ment Health. 19(3):549–552CrossRefGoogle Scholar
  11. Kent A, Hughes P, Ormerod L, Jones G, Thilaganathan B (2002) Uterine artery resistance and anxiety in the second trimester of pregnancy. Ultrasound Obstet Gynecol 19:177–179CrossRefGoogle Scholar
  12. Levinson-Castiel R, Merlob P, Linder N, Dirota L, Klinger G (2006) Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adolesc Med. 160(2):173–176CrossRefGoogle Scholar
  13. Lund N, Pedersen LH, Henriksen TB (2009) Selective serotonin reuptake inhibitor exposure in utero and pregnancy outcomes. Arch Pediatr Adolesc Med 163(10):949–954CrossRefGoogle Scholar
  14. Marcus SM, Flynn HA, Blow FC, Barry KL (2003) Depressive symptoms among pregnant women screened in obstetrics settings. J Women's Health (Larchmt) 12:373–380CrossRefGoogle Scholar
  15. Monk C, Newport DJ, Korotin JH, Long Q, Knight B, Stowe ZN (2012) Uterine blood flow in psychiatric population: impact of maternal depression, anxiety, and psychotropic medication. Biol Psych 72(6):483–490CrossRefGoogle Scholar
  16. Oberlander TF, Warburton W, Misri S, Aghajanian J, Hertzman C (2006) Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data. Arch Gen Psychiatry 63(8):898–906CrossRefGoogle Scholar
  17. Sahingoz M, Yuksel G, Karsidag C, Uguz F, Sonmez EO, Annagur BB, Annagur A (2014) Birth weight and preterm birth in babies of pregnant women with major depression in relation to treatment with antidepressants. J Clin Psychopharmacol 34(2):226–229CrossRefGoogle Scholar
  18. Sanz EJ, De-las-Cuevas C, Kiuru A, Bate A, Edwards R (2005) Selective serotonin re-uptake inhibitors in pregnant women and neonatal withdrawal syndrome: a database analysis. Lancet 365:482–487CrossRefGoogle Scholar
  19. Statistics Canada. Mean and median birth weights by geography. Last updated November 27, 2015. (accessed December 15, 2017)
  20. Statistics Canada. Preterm live births in Canada, 2000 to 2013. Last updated October 26, 2016. (accessed December 15, 2017
  21. Teixeira JM, Fisk NM, Glover V (1999) Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. BMJ 318:153–157CrossRefGoogle Scholar
  22. Viktorin A, Lichtenstein P, Lundholm C, Almqvist C, D’Onofrio BM, Larsson H, Landén M, Magnusson PKE (2016) Selective serotonin re-uptake inhibitor use during pregnancy: association with offspring birth size and gestational age. Int J Epidemiol 45(1):170–177CrossRefGoogle Scholar
  23. Vythilingum B, Geerts L, Fincham D, Roos A, Faure S, Jonkers J, Stein DJ (2010) Association between antenatal distress and uterine artery pulsatility index. Arch Womens Ment Health 13:359–364CrossRefGoogle Scholar
  24. Wen SW, Yang Q, Garner P, Fraser W, Olatunbosun O, Nimrod C, Walker M (2006) Selective serotonin reuptake inhibitors and adverse pregnancy outcomes. Am J Obstet Gynecol 194(4):961–966CrossRefGoogle Scholar
  25. Yonkers KA, Gilstad-Hayden K, Forray A, Lipkind HS (2017) Association of panic disorder, generalized anxiety disorder and benzodiazepine treatment during pregnancy with risk of adverse birth outcomes. JAMA Psyc 74(11):1145–1152CrossRefGoogle Scholar
  26. Zimmerman-Baer U, Notzli U, Rentsch K, Bucher HU (2010) Finnegan neonatal abstinence scoring system: normal values for first 3 days and weeks 5–6 in non-addicted infants. Addiction 105:524–528CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyMount Sinai HospitalTorontoCanada
  2. 2.Department of PsychiatryMount Sinai HospitalTorontoCanada

Personalised recommendations