title: The effect of prenatal antidepressant exposure on neonatal adaptation: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Conflicting reports on potential risks of antidepressant exposure during gestation for the infant have been reported in the literature. This systematic review and meta-analysis on immediate neonatal outcomes were conducted to clarify what, if any, risks are faced by infants exposed to antidepressants in utero. Subanalyses address known methodological limitations in the field.
  
  
  METHODS
  MEDLINE, EMBASE, CINAHL, and PsycINFO were searched from their start dates to June 2010. Various combinations of keywords were utilized including, but not limited to, depressive/mood disorder, pregnancy/pregnancy trimesters, antidepressant drugs, and neonatal effects.
  
  
  METHODS
  English language and cohort and case-control studies reporting on a cluster of signs defined as poor neonatal adaptation syndrome (PNAS) or individual clinical signs (respiratory distress and tremors) associated with pharmacologic treatment were selected. Of 3,074 abstracts reviewed, 735 articles were retrieved and 12 were included in this analysis.
  
  
  METHODS
  Two independent reviewers extracted data and assessed the quality of the articles.
  
  
  RESULTS
  Twelve studies were retrieved that examined PNAS or the signs of respiratory distress and tremors in the infant. There was a significant association between exposure to antidepressants during pregnancy and overall occurrence of PNAS (odds ratio [OR] = 5.07; 95% CI, 3.25-7.90; P < .0001). Respiratory distress (OR = 2.20; 95% CI, 1.81-2.66; P < .0001) and tremors (OR = 7.89; 95% CI, 3.33-18.73; P < .0001) were also significantly associated with antidepressant exposure. For the respiratory outcome, studies using convenience samples had significantly higher ORs (Q1 = 5.4, P = .020). No differences were found in any other moderator analyses.
  
  
  CONCLUSIONS
  An increased risk of PNAS exists in infants exposed to antidepressant medication during pregnancy; respiratory distress and tremors also show associations. Neonatologists need to be prepared and updated in their management, and clinicians must inform their patients of this risk.
authors: Women's Mood and Anxiety Clinic: Reproductive Transitions, Department of Psychiatry, FG 29, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada. Sophie.Grigoriadis@sunnybrook.ca
authors: Sophie
authors: S
authors: Grigoriadis
authors: Emily H
authors: EH
authors: VonderPorten
authors: Lana
authors: L
authors: Mamisashvili
authors: Allison
authors: A
authors: Eady
authors: George
authors: G
authors: Tomlinson
authors: Cindy-Lee
authors: CL
authors: Dennis
authors: Gideon
authors: G
authors: Koren
authors: Meir
authors: M
authors: Steiner
authors: Patricia
authors: P
authors: Mousmanis
authors: Amy
authors: A
authors: Cheung
authors: Lori E
authors: LE
authors: Ross
mesh_terms: D000222:Adaptation, Physiological / Q000187:drug effects / Q000502:physiology*; D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced / Q000453:epidemiology*; D012127:Respiratory Distress Syndrome, Newborn / Q000139:chemically induced / Q000453:epidemiology*; D014202:Tremor / Q000139:chemically induced / Q000453:epidemiology*
chemical_list: D000928:Antidepressive Agents