Elucidating Neonatal Discontinuation Syndrome in Infants Exposed to Antidepressants

Neonatal discontinuation syndrome (NDS) is associated with exposure to an antidepressant during fetal life. NDS is a pattern of signs including trouble breathing, tremors, muscular rigidity, irritability and feeding problems. In America, over 320,000 newborns are exposed to serotonin selective reuptake inhibitor (SSRI) antidepressants every year, NDS occurs in 20-30% (96,000/year), and requires medical treatment in 3% (10,000/year). The reasons that some infants are affected with NDS while others are spared are unknown. Possible explanations for NDS include serotonergic overstimulation due to SSRI exposure, withdrawal due to the rapid drop in antidepressant concentration at birth, and lasting changes in the fetal brain biology that impair adaptation after birth. The proposed study fills this research void by adding sequential fetal ultrasound and infant behavioral assessments to an NICHD-funded investigation, Optimizing Medication Management for Mothers with Depression (OPTI-MOM). This is a comprehensive longitudinal assessment of maternal and fetal exposure to both SSRI and depression across pregnancy. OPTI-MOM is an Obstetric-Fetal Pharmacology Research Center focused on pregnant women; however, behavioral follow-up studies of infants are not included. OPTI-MOM will be leveraged for its detailed assessment of exposures across pregnancy to support an unparalleled opportunity to elucidate the etiology of NDS.