title: Prenatal SSRI exposure alters neonatal corticosteroid binding globulin, infant cortisol levels, and emerging HPA function.
abstract: BACKGROUND
  Serotonin influences the development of the hypothalamic-pituitary-adrenal (HPA) system; therefore prenatal exposure to selective serotonin reuptake inhibitor antidepressants (SSRIs) may alter HPA axis development and function. To address this, prenatal exposure to SSRIs and maternal mood were examined in relation to neonatal and infant levels of cortisol and its binding protein, corticosteroid-binding globulin (CBG).
  
  
  METHODS
  Serum cortisol and CBG levels were assayed from SSRI-exposed and non-exposed mothers and their neonates at delivery. Maternal mood symptoms were documented at 36 weeks gestation. To determine the long-term implications of changes in CBG, levels of salivary cortisol were assessed in infants at 3 months of age.
  
  
  RESULTS
  Prenatal SSRI exposure significantly increased serum CBG levels in neonates after vaginal delivery (p ≤ 0.038), even when controlling for maternal depression. Neonatal serum cortisol levels did not vary with SSRI exposure or antenatal maternal mood, but were significantly higher following vaginal delivery (p ≤ 0.003). Neonatal serum CBG levels were associated with infant salivary levels of evening cortisol (p ≤ 0.051). In SSRI-exposed infants, increased levels of neonatal CBG predicted a smaller diurnal change in infant salivary cortisol (p ≤ 0.028), regardless of maternal depression.
  
  
  CONCLUSIONS
  Prenatal SSRI exposure affects the developing HPA system by altering serum CBG levels in neonates and infant salivary cortisol levels. Further research is warranted on the long-term functional implications of the effect of prenatal SSRI exposure on fetal hepatic CBG gene expression and the developing HPA system.
authors.affiliation: Early Human Experience Unit, Department of Pediatrics, Child and Family Research Institute, University of British Columbia, Vancouver, Canada. j.pawluski@maastrichtuniversity.nl
authors.forename: Jodi L
authors.initials: JL
authors.lastname: Pawluski
authors.forename: Ursula M
authors.initials: UM
authors.lastname: Brain
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Underhill
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Hammond
authors.forename: Tim F
authors.initials: TF
authors.lastname: Oberlander
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D003863:Depression / Q000188:drug therapy; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects* / Q000254:growth & development / Q000378:metabolism / Q000502:physiology; D007223:Infant; D007231:Infant, Newborn / Q000097:blood / Q000378:metabolism*; D008297:Male; D018811:Maternal Exposure / Q000706:statistics & numerical data; D010913:Pituitary-Adrenal System / Q000187:drug effects* / Q000254:growth & development / Q000378:metabolism / Q000502:physiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D011297:Prenatal Exposure Delayed Effects / Q000097:blood / Q000139:chemically induced / Q000378:metabolism / Q000503:physiopathology; D012463:Saliva / Q000187:drug effects / Q000378:metabolism; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D014156:Transcortin / Q000378:metabolism*
chemical_list: D000928:Antidepressive Agents; D006854:Hydrocortisone; D017367:Selective Serotonin Reuptake Inhibitors; D014156:Transcortin; C534935:SERPINA6 protein, human