SSRIs and SNRIs (SRI) in Pregnancy: Effects on the Course of Pregnancy and the Offspring: How Far Are We from Having All the Answers?
Abstract
:1. Introduction
2. Major Congenital Malformations and Cardiac Anomalies
3. Complications of Pregnancy
3.1. Spontaneous Abortions, Fetal and Perinatal Death
3.2. Prematurity and Intrauterine Growth Restriction (IUGR)
4. Neonatal Effects
4.1. Poor Neonatal Adaptation
4.2. Persistent Pulmonary Hypertension of the Newborn (PPHN)
5. Neurodevelopmental Effects
6. Possible Association with Autism Spectrum Disorder (ASD)
7. Epigenetic Changes
8. Pregnancy-Induced Changes in SRI Metabolism, Interaction with Genotype, Pharmacodynamics and Pharmacokinetic Changes
9. Future Research Directions and Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Issue Studied | References | Results | Comments |
---|---|---|---|
Original studies looking at major congenital malformations | [13,14,15,16,17,18,19,20] | No increase | Consensus in most studies that, in general, there is no increase in the rate of major malformations |
Original studies looking at cardiac malformations | [15,21,22,23,24,25,26,28,29,30,31,32,33,34] | Possible increase of severe cardiac anomalies | Issue in debate: Large studies are generally positive, especially demonstrating an increase in rare, severe, cardiac malformations. Other studies have shown a similar increase in untreated mothers with depression |
Original studies looking at miscarriage and stillbirths | [15,47,48,49,50,51,52] | Generally no increase | The slight increase is related to maternal disease or gestational age at study |
Original studies looking at preterm birth and low birth weight | [49,52,53,54,55,56,57,58,59] | Generally no increase in preterm birth and no effects on fetal growth | The slight increase in preterm birth and possible decreased fetal growth are related to maternal disease |
Issue Studied | Reference | Results | Comments |
---|---|---|---|
Poor neonatal adaptation | [63,64,65,66,67] | SRI may interfere with neonatal adaptation | Present in up to 30% of newborn infants. Generally no long-term sequelae |
PPHN | [6,68,69,70,71,72] | SRI may increase the rate of PPHN | Less than 1%, not very severe, apparently no death reported |
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Ornoy, A.; Koren, G. SSRIs and SNRIs (SRI) in Pregnancy: Effects on the Course of Pregnancy and the Offspring: How Far Are We from Having All the Answers? Int. J. Mol. Sci. 2019, 20, 2370. https://doi.org/10.3390/ijms20102370
Ornoy A, Koren G. SSRIs and SNRIs (SRI) in Pregnancy: Effects on the Course of Pregnancy and the Offspring: How Far Are We from Having All the Answers? International Journal of Molecular Sciences. 2019; 20(10):2370. https://doi.org/10.3390/ijms20102370
Chicago/Turabian StyleOrnoy, Asher, and Gideon Koren. 2019. "SSRIs and SNRIs (SRI) in Pregnancy: Effects on the Course of Pregnancy and the Offspring: How Far Are We from Having All the Answers?" International Journal of Molecular Sciences 20, no. 10: 2370. https://doi.org/10.3390/ijms20102370