Newborn neurobehavioral patterns are differentially related to prenatal maternal major depressive disorder and serotonin reuptake inhibitor treatment

Abstract

Background: Prenatal serotonin reuptake inhibitor (SRI) exposure has been related to adverse newborn neurobehavioral outcomes; however, these effects have not been compared to those that may arise from prenatal exposure to maternal major depressive disorder (MDD) without SRI treatment. This study examined potential effects of MDD with and without SRI treatment on newborn neurobehavior.

Methods: This was a prospective, naturalistic study. Women were seen at an outpatient research center twice during pregnancy (26-28 and 36-38 weeks gestational age (GA)). Psychiatric diagnoses were assessed using the Structured Clinical Interview for the DSM-IV; medication use was measured with the Timeline Follow-Back instrument. Three groups were established based upon MDD diagnosis and SRI use: Control (N = 56), MDD (N = 20), or MDD + SRI (N = 36). Infants were assessed on a single occasion within 3 weeks of birth with the NICU Network Neurobehavioral Assessment Scale. Generalized Linear Modeling was used to examine neurobehavioral outcomes by exposure group and infant age at assessment.

Results: Full-term infants exposed to MDD + SRIs had a lower GA than CON or MDD-exposed infants and, controlling for GA, had lower quality of movement and more central nervous system stress signs. In contrast, MDD-exposed infants had the highest quality of movement scores while having lower attention scores than CON and MDD + SRI-exposed infants.

Conclusion: MDD + SRI-exposed infants seem to have a different neurobehavioral profile than MDD-exposed infants in the first 3 weeks after delivery; both groups may have different neurobehavioral profiles with increasing age from birth.

Figure 1

Attention scores. Although the plots show varying relationships by group, the interactions were not significant. In addition to the exposure group main effect, the main effect of age was significant; overall attention scores increased with age at assessment. Figures 1–6 represent the scatterplots of estimated marginal means of significant NNNS summary variables plotted against the log-transformed age at infant assessment for each medication exposure group. A Loess curve was fit to the data to examine possible nonlinear relationships.

Figure 2

Quality of Movement scores. Although there were significant group differences, there were no significant relationships with infant age at assessment.

Figure 3

Number of CNS Stress Signs. Infants in the MDD+SRI group had fewer CNS stress signs with increasing age at assessment compared to the CON group.

Figure 4

Arousal scores. Infants in the MDD group had lower arousal scores with increasing age at assessment compared to the CON group.

Figure 5

Number of Handling maneuvers required to maintain a quiet alert state in the infant. Infants in the MDD group required less handling with increasing age at assessment compared to the CON group.

Figure 6

Lethargy scores; Overall, infants had lower lethargy scores with increasing age at assessment. However, there was marginal but non-significant MDD × AGE interaction, suggesting higher lethargy scores with increasing age at assessment compared to the CON group.