Perinatal outcome following third trimester exposure to paroxetine.
BACKGROUND
Paroxetine hydrochloride is commonly used for maternal depression, panic disorder, and obsessive-compulsive disorder. The drug readily crosses the human placenta. Although it does not appear to increase teratogenic risk, there have been case reports of neonatal withdrawal. Symptoms were described soon after birth and lasted up to 1 month.


OBJECTIVE
To investigate whether there is a clinically important discontinuation syndrome in neonates exposed to paroxetine in utero.


METHODS
Prospective, controlled cohort study.


METHODS
Fifty-five pregnant women counseled prospectively by the Motherisk program in Toronto, Ontario, regarding third-trimester exposure to paroxetine and their infants were included in the study group. Pregnant women who discontinued paroxetine before the third trimester or those receiving other drugs known to cause withdrawal-type symptoms, such as opioids or benzodiazepines, were excluded. A comparison group of 27 women using paroxetine during the first or second trimester and 27 women using nonteratogenic drugs were matched for maternal age, gravity, parity, social drug use, and nonteratogenic drug use.


RESULTS
Of the 55 neonates exposed to paroxetine in late gestation, 12 had complications necessitating intensive treatment and prolonged hospitalization. The most prevalent clinical picture was respiratory distress (n = 9), followed by hypoglycemia (n = 2), and jaundice (n = 1). The symptoms disappeared within 1 to 2 weeks. In the comparison group, only 3 infants experienced complications (P =.03). In logistic regression, only third-trimester exposure to paroxetine was associated with neonatal distress (odds ratio, 9.53; 95% confidence interval, 1.14-79.3).


CONCLUSIONS
When used near term, paroxetine is associated with a high rate of neonatal complications, possibly caused by its common discontinuation syndrome.
Costei
Adriana Moldovan
AM
the Motherisk program, Division of Clinical Pharmacology/Toxicology, the Hospital for Sick Children, Toronto, Ontario, Canada.
Kozer
Eran
E
Ho
Tommy
T
Ito
Shinya
S
Koren
Gideon
G
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007231:Infant, Newborn; D007565:Jaundice / Q000139:chemically induced; D008431:Maternal-Fetal Exchange; D009357:Neonatal Abstinence Syndrome / Q000209:etiology*; D017374:Paroxetine / Q000009:adverse effects*; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000139:chemically induced*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors