Related Experiment Video
Updated: May 11, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
The effect of prenatal antidepressant exposure on neonatal adaptation: a systematic review and meta-analysis
Sophie Grigoriadis1, Emily H VonderPorten, Lana Mamisashvili
1Women'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
Insights
Infants exposed to antidepressants during pregnancy face increased risks of poor neonatal adaptation syndrome (PNAS), including respiratory distress and tremors. Clinicians should inform pregnant patients about these potential risks.
Area of Science:
- Perinatal medicine
- Neonatology
- Pharmacology
Background:
- Conflicting reports exist regarding the risks of antidepressant exposure during pregnancy.
- Immediate neonatal outcomes require clarification for infants exposed to antidepressants in utero.
Purpose of the Study:
- To systematically review and meta-analyze immediate neonatal outcomes associated with in utero antidepressant exposure.
- To address methodological limitations in existing research through subanalyses.
Main Methods:
- Searched MEDLINE, EMBASE, CINAHL, and PsycINFO databases up to June 2010.
- Included English language cohort and case-control studies on poor neonatal adaptation syndrome (PNAS), respiratory distress, and tremors.
- Two independent reviewers extracted data and assessed study quality.
Main Results:
- Twelve studies examined PNAS or specific neonatal signs.
- Significant association found between antidepressant exposure and PNAS (OR=5.07).
- Increased risk for respiratory distress (OR=2.20) and tremors (OR=7.89) in exposed infants.
Conclusions:
- Infants exposed to antidepressants during pregnancy have an increased risk of PNAS, respiratory distress, and tremors.
- Neonatologists require updated management protocols.
- Clinicians must counsel patients on these risks.
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.
Data Sources:
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.
Study Selection:
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.
Data Extraction:
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.
