Risks associated with in utero and lactation exposure to selective serotonin reuptake inhibitors (SSRIs)

BackgroundPrenatal exposure to selective serotonin reuptake inhibitors (SSRIs) may increase risk for congenital malformations and adverse perinatal outcome.ObjectiveThis article reviews the published literature on exposure to SSRIs in utero and during lactation.MethodsLiterature search in PubMed.ResultsThere is no conclusive evidence for increased risk for malformations but paroxetine and possibly fluoxetine use in early pregnancy may be associated with a small increased risk for cardiovascular malformations. Perinatal adverse effects, including respiratory distress and neonatal adaptation problems are common in exposed infants, and an increased risk for persistent pulmonary hypertension of the newborn (PPHN) has been observed. The suspected increased risk of preterm birth, low birth weight or small for gestational age has not been confirmed. It is not clear to what extent the adverse effects observed in some studies are attributable to the drug effect or related to mother's underlying disease and other possible confounders. The SSRIs are usually compatible with breastfeeding, however, individual variations in infant exposure may occur.