title: Hypothalamic-pituitary-adrenal (HPA) axis function in 3-month old infants with prenatal selective serotonin reuptake inhibitor (SSRI) antidepressant exposure.
abstract: BACKGROUND
  Prenatal exposure to stress and selective serotonin reuptake inhibitors (SSRIs) alter hypothalamic-pituitary-adrenal (HPA) stress reactivity in offspring, however, the effects of combined exposure to HPA activity in human infants is unknown.
  
  
  OBJECTIVE
  To examine HPA basal levels and stress responsiveness in 3-month olds with prenatal exposure to SSRIs.
  
  
  METHODS
  Salivary cortisol levels in infants of SSRI treated mothers (n=31, mean exposure 230.2+/-72.2 days) were compared with non-SSRI exposed (n=45) infants in response to a challenge (infant-controlled habituation task) and under basal conditions in the late afternoon/early evening. Mode of feeding, to account for possible postnatal drug exposure via breast milk, as well as measures of pre and postnatal maternal mood, were included as covariates.
  
  
  RESULTS
  Lower post-stress cortisol levels were observed in non-SSRI exposed/non-breastfed infants compared with non-SSRI exposed infants who were breastfed at 3 months of age. Stress reactivity patterns among SSRI exposed infants did not differ with mode of feeding. The cortisol reactivity slope (CRS) was significantly lower among non-SSRI exposed non-breastfed infants compared with non-SSRI exposed breastfed infants. Early evening basal cortisol levels were lower in SSRI exposed infants than in non-SSRI exposed infants, controlling for maternal mood and mode of feeding. Postnatal SSRI exposure (infant SSRI drug levels) via breast milk was not associated with stress or basal cortisol levels. Total cortisol, reflected by the AUC measure, did not differ significantly between exposure groups.
  
  
  CONCLUSIONS
  Prenatal SSRI exposure altered HPA stress response patterns and reduced early evening basal cortisol levels. Stress challenge HPA response differences only became apparent when the moderating effect of method of feeding was accounted for. These findings suggest an early "programming" effect of antenatal maternal mood, prenatal SSRI exposure and postnatal maternal care giving on the HPA system.
authors.affiliation: Department of Pediatrics, UBC, Vancouver, BC, Canada V6H 3V4. toberlander@cw.bc.ca
authors.forename: Tim F
authors.initials: TF
authors.lastname: Oberlander
authors.forename: Ruth
authors.initials: R
authors.lastname: Grunau
authors.forename: Linda
authors.initials: L
authors.lastname: Mayes
authors.forename: Wayne
authors.initials: W
authors.lastname: Riggs
authors.forename: Dan
authors.initials: D
authors.lastname: Rurak
authors.forename: Michael
authors.initials: M
authors.lastname: Papsdorf
authors.forename: Shaila
authors.initials: S
authors.lastname: Misri
authors.forename: Joanne
authors.initials: J
authors.lastname: Weinberg
mesh_terms: D000328:Adult; D000339:Affect / Q000187:drug effects; D000928:Antidepressive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D003863:Depression / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000378:metabolism; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects* / Q000378:metabolism / Q000502:physiology; D007223:Infant; D010913:Pituitary-Adrenal System / Q000187:drug effects* / Q000378:metabolism / Q000502:physiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced*; D012463:Saliva / Q000737:chemistry / Q000187:drug effects; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D013315:Stress, Psychological / Q000150:complications / Q000188:drug therapy
chemical_list: D000928:Antidepressive Agents; D006854:Hydrocortisone; D017367:Selective Serotonin Reuptake Inhibitors