Advertisement

Evaluation of neonatal withdrawal syndrome in neonates delivered by women taking psychotropic or anticonvulsant drugs: A retrospective chart review of the effects of multiple medications and breastfeeding

Published:September 23, 2020DOI:https://doi.org/10.1016/j.ejogrb.2020.09.008

      Highlights

      • Most withdrawal symptoms are mild in neonates of women taking psychotropic drugs.
      • The risk is increased when a mother is administered with multiple drugs.
      • Breastfeeding may be protective against withdrawal symptoms.

      Abstract

      Objectives

      Neonates delivered by women who were taking psychotropic or anticonvulsant drugs during pregnancy are at increased risk of developing neonatal withdrawal syndrome. We investigated the incidence of neonatal withdrawal symptoms and the effects of multiple maternal medications and breastfeeding on neonatal withdrawal symptoms.

      Study Design

      This study examined the overall incidence of neonatal withdrawal symptoms in neonates delivered from 2004 to 2016 by women who were taking oral antipsychotics, antidepressants, anxiolytics, sedatives, or anticonvulsant drugs during pregnancy. Moreover, we compared the incidence of neonatal symptoms between mothers taking single drugs and multiple drugs, and between breastfed and formula-fed neonates. We scored the neonates according to the neonatal withdrawal syndrome checklist created by Isobe et al., which is widely used in Japan.

      Results

      We examined 131 mothers and their 134 neonates. Withdrawal symptoms were found in 54.5 % of neonates. Symptoms were found in 32.4 % of neonates delivered by mothers taking single drugs and 62.9 % of neonates delivered by mothers taking two or more drugs (p = 0.0019). One or more withdrawal symptoms developed in 46.4 % of breastfed neonates and 66.1 % of formula-fed neonates (p = 0.034). Five infants had a score of 8 or more points on the withdrawal checklist, which is an indication to consider treatment with pharmacotherapy. All five of these neonates were mainly formula-fed, and their mothers were taking two or more drugs.

      Conclusions

      The incidence of withdrawal symptoms was high in neonates delivered by women taking psychotropic or anticonvulsant drugs; however, there were few serious cases. The risk increased when a mother was taking multiple drugs. Breastfeeding appeared to protect against withdrawal symptoms.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • Nishi D.
        • Ishikawa H.
        • Kawakami N.
        Prevalence of mental disorders and mental health service use in Japan.
        Psychiatry Clin Neurosci. 2019; 73: 458-465
        • Jones I.
        • Chandra P.S.
        • Dazzan P.
        • Howard L.M.
        Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period.
        Lancet. 2014; 384: 1789-1799
        • Viguera A.C.
        • Whitfield T.
        • Baldessarini R.J.
        • Newport D.J.
        • Stowe Z.
        • Reminick A.
        • et al.
        Risk of recurrence in women with bipolar disorder during pregnancy:prospective study of mood stabilizer discontinuation.
        Am J Psychiatry. 2007; 164: 1817-1824
        • Ter Horst P.G.
        • Jansman F.G.
        • van Lingen R.A.
        • Smit J.P.
        • de Jong-van den Berg L.T.
        • Brouwers J.R.
        Pharmacological aspect of neonatal antidepressant withdrawal.
        Obstet Gynecol Surv. 2008; 63: 267-279
        • Isobe K.
        • Ishii M.
        • Kusaka T.
        Research on systemic care system for a high risk child management of newborn babies with the withdrawal syndrome. Questionnaire survey on evaluation method by a check list and score table.
        1995 (Accessed 2020-04-12)
      1. Japan ministry of health, labour and welfare.
        2010 (Accessed 2020-04-12)
        • Finnegan L.P.
        • Connaughton Jr., J.F.
        • Kron R.E.
        • Emich J.P.
        Neonatal abstinence syndrome:assessment and management.
        Addict Dis. 1975; 2: 141-158
        • Lipsitz P.J.
        A proposed narcotic withdrawal score for use with newborn infants. A pragmatic evaluation of its efficacy.
        Clin Pediatr. 1975; 14: 592-594
        • Sarkar S.
        • Donn S.M.
        Management of neonatal abstinence syndrome in neonatal intensive care units: a national survey.
        J Perinatol. 2006; 26: 15-17
        • Kuschel C.
        Managing drug withdrawal in the newborn infant.
        Semin Fetal Neonat Med. 2007; 12: 127-133
        • Davies H.
        • Gilbert R.
        • Johnson K.
        • Petersen I.
        • Nazareth I.
        • O’Donnell M.
        • et al.
        Neonatal drug withdrawal syndrome: cross-country comparison using hospital administrative data in England, the USA, Western Australia and Ontario, Canada.
        Arch Dis Child Fetal Neonatal Ed. 2016; 101: 26-30
        • Tolia V.N.
        • Patrick S.W.
        • Bennett M.M.
        • et al.
        Increasing incidence of the neonatal abstinence syndrome in U.S. neonatal ICUs.
        N Engl J Med. 2015; 372: 2118-2126
        • Yang A.
        • Ciolino J.D.
        • Pinheiro E.
        • Rasmussen-Torvik L.J.
        • Sit D.K.Y.
        • Wisner K.L.
        Neonatal discontinuation syndrome in serotonergic antidepressant–exposed neonates.
        J Clin Psychiatry. 2017; 78: 605-611
        • Oberlander T.F.
        • Misri S.
        • Fitzgerald C.E.
        • Kostaras X.
        • Rurak D.
        • Riggs W.
        Pharmacologic factors associated with transient neonatal symptoms following prenatal psychotropic medication exposure.
        J Clin Psychiatry. 2004; 65: 230-237
        • Levinson-Castiel R.
        • Merlob P.
        • Linder N.
        • Sirota L.
        • Klinger G.
        Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants.
        Arch Pediatr Adolesc Med. 2006; 160: 173-176
        • Kieviet N.
        • Hoppenbrouwers C.
        • Dolman K.M.
        • Berkhof J.
        • Wennink H.
        • Honig A.
        Risk factors for poor neonatal adaptation after exposure to antidepressants in utero.
        Acta Paediatr. 2015; 104: 384-391
        • Koren G.
        • Moretti M.
        • Kapur B.
        Can venlafaxine in breast milk attenuate the norepinephrine and serotonin reuptake neonatal withdrawal syndrome.
        J Obstet Gynaecol Can. 2006; 28: 299-301
        • Balain M.
        • Johnson K.
        Neonatal abstinence syndrome: the role of breastfeeding.
        Infant. 2014; 10: 9-13
        • Hudak M.L.
        • Tan R.C.
        Committee on drugs; committee on fetus and newborn; American academy of pediatrics. Neonatal drug withdrawal.
        Pediatrics. 2012; 129: e540-60