Deakin University
lewis-neonataladaptation-2017.pdf (201.11 kB)

Neonatal adaptation following intrauterine antidepressant exposure: assessment, drug assay levels, and infant development outcomes

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journal contribution
posted on 2017-11-01, 00:00 authored by Megan Galbally, Olav Spigset, Andrew R Johnson, Rolland Kohan, Martha Lappas, Andrew Lewis
BackgroundAlthough a meta-analysis has confirmed the association between antidepressant exposure in utero and subsequent poor neonatal adaptation, few identified studies included drug levels or standardized measures and only two studies followed up children who developed symptoms beyond infancy.MethodsThe study draws on the Mercy Pregnancy and Emotional Wellbeing Study and reports on 42 women/infant pairs at delivery. In all, 31 women continued to take antidepressants until delivery and 11 ceased earlier in pregnancy. Poor neonatal adaptation was assessed twice daily for up to 6 days by using the Neonatal Abstinence Scoring System (NASS). Drug levels were analyzed in umbilical cord blood and maternal blood obtained at delivery.ResultsIn total, 76% (32 of 42) of neonates exposed to antidepressants had symptoms observed on the NASS. These symptoms occurred up to 5 days postpartum with 25% having symptoms that persisted for more than 3 days. The most frequent symptoms were correlated most closely to antidepressant drug levels. Elevated NASS scores were found to be associated with poorer fine motor development at 6 months of age.ConclusionsPoor neonatal adaptation may be more common than previously recognized. The NASS was observed to be an effective assessment and monitoring measure. Research following symptomatic infants beyond the neonatal period is required.



Pediatric research






806 - 813


Nature Publishing Group


New York, N.Y.





Publication classification

C1 Refereed article in a scholarly journal

Copyright notice

2017, International Pediatric Research Foundation, Inc.