Effect of exposure to selective serotonin reuptake inhibitors in utero on fetal growth: potential role for the IGF-I and HPA axes.
To investigate the possible effect of fetal exposure to selective serotonin reuptake inhibitors (SSRIs) on somatic growth and on hormones of the hypothalamic-pituitary-adrenal (HPA) and insulin-like growth factor (IGF)-I axes, we compared the anthropometric parameters and hormonal profile of 21 SSRI-exposed infants and 20 matched controls. The SSRI group was characterized by lower crown-heel length (p < 0.01), smaller head circumference (p = 0.08), and higher percentage of infants with birth weight, birth length, and head circumference below the 10th percentile (p < 0.045, p = 0.08, p < 0.04, respectively), in addition to a significantly lower cord blood level of cortisol (p < 0.03) and higher level of thyroid-stimulating hormone (TSH) (p < 0.004). Infants exposed to citalopram had a lower cord blood IGF-I level than infants exposed to paroxetine (p < 0.001) and controls (p < 0.003). Placental IGF-I receptor (IGF-IR) expression was significantly higher in the SSRI group than in controls (p < 0.01). Urine 5-hydroxyindoleacetic acid (5-HIAA) level was negatively correlated with birth weight (r = -0.71, p < 0.025) and with dehydroepiandrosterone (DHEA) level (r = -0.71, p < 0.025). The Finnegan score was correlated with dehydroepiandrosterone sulfate (DHEAS) (r = 0.8, p < 0.005) and cortisol (r = 0.62, p = 0.05). Fetal exposure to SSRIs causes impaired intrauterine growth accompanied by alterations in the IGF-I and HPA axes. The findings may raise concern regarding maternal use of SSRIs during pregnancy.
Davidson
Shmuel
S
Department of Neonatology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tiqwa 49100, Israel. shmueld@clalit.org.il
Prokonov
Diana
D
Taler
Michal
M
Maayan
Rachel
R
Harell
Daniella
D
Gil-Ad
Irit
I
Weizman
Abraham
A
D000328:Adult; D001724:Birth Weight / Q000187:drug effects; D016022:Case-Control Studies; D015283:Citalopram / Q000009:adverse effects; D005260:Female; D005312:Fetal Blood / Q000378:metabolism; D047109:Fetal Development / Q000187:drug effects*; D005317:Fetal Growth Retardation / Q000139:chemically induced* / Q000378:metabolism; D005333:Fetus / Q000187:drug effects* / Q000378:metabolism; D005473:Fluoxetine / Q000009:adverse effects; D006728:Hormones / Q000097:blood; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects* / Q000378:metabolism; D007231:Infant, Newborn; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008297:Male; D017374:Paroxetine / Q000009:adverse effects; D010913:Pituitary-Adrenal System / Q000187:drug effects* / Q000378:metabolism; D010920:Placenta / Q000378:metabolism; D011247:Pregnancy; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
D015283:Citalopram; D005473:Fluoxetine; D006728:Hormones; D007334:Insulin-Like Growth Factor I; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors