Prenatal exposure to serotonin reuptake inhibitors: a case report

Selective serotonin reuptake inhibitor (SSRI) antidepressants are considered the primary treatments for depression and anxiety in pregnancy. Since intrauterine exposure to these drugs has been associated with poor neonatal adaptation, low birth weight, RDS, neurobehavioural symptoms, and potential teratogenic effects, further studies are needed to assess risks and mechanism of action of SSRIs. Meanwhile, it is advisable to evaluate for each patient the real risk/benefit ratio of continuing or suspending treatment during pregnancy.Recent studies report that depression and anxiety disorders affect 12-18% and 1.5-5% of pregnant women, respectively [1]. Selective serotonin reuptake inhibitor (fluoxetine, paroxetine, sertraline, etc) are considered the primary treatments for these disorders. In recent years several concerns have been raised about safety of some antidepressants during pregnancy.In utero exposure to an SSRI has been associated with many neonatal symptoms, including respiratory distress, feeding difficulties, and a wide spectrum of neurological symptoms. A neonatal abstinence syndrome (NAS), resulting from exposure to SSRIs during pregnancy, may explain this clinical syndrome, characterized by central nervous system, gastrointestinal, autonomic and respiratory symptoms [2,3]. In a cohort study, symptoms of NAS were present in 30% of exposed infants compared to none of the non-exposed control infants [4].Furthermore, concerns regarding persistent pulmonary hypertension, teratogenic risks, and neonatal adaptation have also been raised. In particular, recent studies have indicated an increased prevalence of certain malformations, as omphalocele, craniosynostosis, and, more consistently, heart defects in newborns exposed to SSRIs in utero [4-8].We here report details of two premature twins who, after in uteroexposure to SSRIs, presented symptoms compatible with the NAS and cardiovascular malformations.We describe the case of two monozygotic, naturally conceived