title: Serotonin and poor neonatal adaptation after antidepressant exposure in utero.
abstract: OBJECTIVE
  Infants exposed to selective antidepressants (SADs) in utero are at risk to develop poor neonatal adaptation (PNA) postpartum. As symptoms are non-specific and the aetiology of PNA is unknown, the diagnostic process is hampered. We hypothesised that the serotonin metabolism plays a role in the aetiology of PNA.
  
  
  METHODS
  In this controlled study, infants admitted postpartum from February 2012 to August 2013 were included and followed for 3 days. Infants exposed to SADs during at least the last 2 weeks of fetal life were included in the patient group (n=63). Infants not exposed to psychotropic medication and admitted postpartum for another reason were included in the control group (n=126). The neonatal urinary 5-hydroxyindoleacetid acid (5-HIAA) levels of SAD-exposed infants who developed PNA, SAD-exposed infants who did not develop PNA and control infants were compared.
  
  
  RESULTS
  The course of the 5-HIAA levels over the first 3 days postpartum differed between infants with and without PNA (p≤0.001) with higher 5-HIAA levels in infants with PNA on day 1 (2.42 mmol/mol, p=0.001). Presence of maternal psychological distress modified this relationship.
  
  
  CONCLUSIONS
  A transient disturbance of the neonatal serotonergic system may play a role in the aetiology of PNA. Other factors, including the presence of maternal psychological distress, also seem to play a role.
authors.affiliation: 1Department of Pediatrics,Psychiatry Obstetric Pediatric Expert Center,OLVG West Hospital,Amsterdam,The Netherlands.
authors.forename: Noera
authors.initials: N
authors.lastname: Kieviet
authors.affiliation: 1Department of Pediatrics,Psychiatry Obstetric Pediatric Expert Center,OLVG West Hospital,Amsterdam,The Netherlands.
authors.forename: Vera
authors.initials: V
authors.lastname: van Keulen
authors.affiliation: 2Department of Epidemiology and Biostatistics,VU Medical Center,Amsterdam,The Netherlands.
authors.forename: Peter Marinus
authors.initials: PM
authors.lastname: van de Ven
authors.affiliation: 1Department of Pediatrics,Psychiatry Obstetric Pediatric Expert Center,OLVG West Hospital,Amsterdam,The Netherlands.
authors.forename: Koert Melchior
authors.initials: KM
authors.lastname: Dolman
authors.affiliation: 3Clinical Laboratory,OLVG West Hospital,Amsterdam,The Netherlands.
authors.forename: Martine
authors.initials: M
authors.lastname: Deckers
authors.affiliation: 4Department of Psychiatry,OLVG West Hospital,AmsterdamThe Netherlands.
authors.forename: Adriaan
authors.initials: A
authors.lastname: Honig
mesh_terms: D000222:Adaptation, Physiological / Q000187:drug effects*; D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007211:Indoles / Q000652:urine; D007223:Infant; D007231:Infant, Newborn; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced / Q000503:physiopathology*; D012701:Serotonin / Q000378:metabolism*; D013315:Stress, Psychological
chemical_list: D000928:Antidepressive Agents; D007211:Indoles; D012701:Serotonin; C024139:indole-3-lactic acid
keywords: SSRI; central nervous system; depression; psychopharmacology