Is antenatal exposure to selective serotonin reuptake inhibitors associated with a prolonged QT interval in term neonates (37 weeks gestation or greater) When it is assessed on an electrocardiogram at 48 – 72 hours of age

Abstract

Selective serotonin reuptake inhibitors (SSRIs) are a group of antidepressants which when utilised in pregnancy are known to increase the risk of prematurity and neonatal abnormalities including persistent pulmonary hypertension of the newborn, congenital defects and withdrawal symptoms. SSRIs are also known to prolong the QT interval in the electrocardiogram of adults, which can lead to sudden death, but limited data are available for neonates.

This prospective case-controlled study therefore sought to examine whether there was an association between antenatal exposure to SSRIs and a prolonged QT interval on the electrocardiogram of term (37 weeks gestation or greater) neonates at 48- 72 hours of age. A group of neonates who were exposed to SSRIs in utero received an electrocardiogram at 48-72 hours old (case group). They were compared with healthy neonates whose mothers did not take SSRIs in pregnancy, but who were still in hospital at 48-72 hours (control group). Of the 43 case neonates and 45 control neonates who had an electrocardiogram (ECG), all had a normal QT interval when screened at 48-72 hours old. Most of the women who used antenatal SSRIs were being treated for depression and/or anxiety with sertraline being the most commonly used SSRI.

No association was found between antenatal exposure to SSRIs and a prolonged QT interval in term neonates when assessed at 48-72 hours old, however the study was underpowered, and the result should be interpreted with caution.

Based on these findings, there is no justification to change practice and implement an ECG screening programme as part of postnatal care for SSRI exposed neonates. Further research may be considered, but based on this study’s feasibility would not be warranted within the current fiscal climate of the NHS

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Identifiers

ORCID for Elizabeth R Cluett: orcid.org/0000-0002-8707-5042

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