In 2001, a research paper from a team based in Norway, headed by H. Nordeng, presented the results of a study titled “Neonatal withdrawal syndrome after in utero exposure to selective serotonin reuptake inhibitors [(SSRIs)],” the main conclusion of which was that “Neonatal withdrawal syndrome can occur after third trimester in utero SSRI exposure.”
This study reviews five cases of neonatal withdrawal syndrome in children exposed to SSRIs before birth, three of whom were exposed to Paxil® (paroxetine), one exposed to Prozac® (fluoxetine), and one exposed to Celexa® (citalopram).
Nordeng et al. write that the main symptoms of neonatal withdrawal syndrome from SSRI antidepressant exposure during pregnancy include “irritability, constant crying, shivering, increased tonus, eating and sleeping difficulties and convulsions.” Symptoms were stated to begin within the first few days of life and “lasted up to one month after birth.” It is important to note here that “all mothers used normal dosing of SSRIs.” (emphasis added)
Shortly after birth, each infant was scored using the Neonatal Abstinence Score (NAS), a test to determine whether a child had become addicted to medications or drugs the mother used during pregnancy. A “score of above 4 points suggests withdrawal symptoms, and a score of above 8 points indicates withdrawal symptoms in need of medical treatment.”
Case 1 – Exposure to Paxil® before birth
This child was born full term with normal weight, but was admitted to the hospital after 5 days for symptoms including “severe irritability” and problems eating and sleeping. The NAS score of this child was 18 upon admission, indicating SSRI withdrawal symptoms in dire need of medical treatment. With feeding tube and medication, the child’s symptoms eventually subsided, and fortunately, after about six months, the child was developing normally.
Case 2 – Exposure to Paxil® before birth
In this case, a mother who had used Paxil® “during the last 4 [months] of her pregnancy” gave birth to a full-term, well-adapted child at normal birth weight. However, shortly after birth, the child exhibited a dramatically increased rate of breath, “had increased tonus with increased reflexes, [and] was shivering”. The authors write that “The symptoms were interpreted as withdrawal symptoms caused by the mother’s use of paroxetine.” After about ten days, and with constant medication, the child’s symptoms resolved.
Case 3 – Exposure to Paxil® before birth
This child was born at full term, at a normal weight, to a mother who had used Paxil® until four days before the birth of her child. A few days after birth, the child was admitted to the hospital for “irritability, inconsolable crying and increased tonus,” and because of “weak sucking,” the child had to use a feeding tube for nourishment. Again, the authors write that “The symptoms were interpreted as withdrawal symptoms with a neonatal abstinence score above 8.” With medication taken every six hours, after four weeks, the child was discharged, though “still shivering and had a slightly increased tonus, but he was now able to suck, and his weight had increased.”
Case 4 – Exposure to Prozac® before birth
This child, exposed to 20mg of Prozac® daily before birth, was born after only 27 weeks and at a dramatically decreased birth weight, and was thus quickly transferred to a neonatal intensive care unit. With a NAS score above 8, doctors concluded that symptoms of irritability, agitation, and convulsions were attributable to maternal use of SSRI medications during pregnancy. After one week, these symptoms resolved, but due to prematurity, the child was not discharged from the hospital for three months.
Case 5 – Exposure to Celexa® before birth
This child, born to a mother who used Celexa (20mg/day) after the 5th month of pregnancy, was born at normal birth weight and full-term. With a NAS score of 4-6, no medical treatment was required, but symptoms of increased muscle tone in the extremities and jitteriness in the neck were observed. After one week, the jitteriness subsided, but the child was released, though with increased muscle tone remaining.
Discussing the findings of this study as a whole, the authors emphasize that case reports such as these cannot illustrate the frequency of these occurrences, nor do they themselves constitute a causal relationship between maternal use of SSRIs during pregnancy and the onset of neonatal abstinence syndrome. Nonetheless, we must also heed the conclusions of the physicians in contact with these children who believed and documented time and time again that the symptoms observed resulted from this maternal medication use.
The authors of this piece conclude that “there is an urgent need for more knowledge. This can only be acquired by close follow-up after birth of newborns exposed to SSRIs in utero.”
SSRI Birth Defect Lawsuits
Because the warning labels for Paxil®, Prozac®, and Celexa® do not include information regarding the possibility of neonatal abstinence syndrome in children born to mothers who used these drugs during pregnancy, a number of SSRI birth defect lawsuits are currently being filed. If you used an SSRI during pregnancy and your child was born with neonatal abstinence syndrome, please do not hesitate to contact our team of Paxil® birth defects lawyers, Prozac® birth defects lawyers, and Celexa® birth defects lawyers at the information provided below.
We have the experience, resources, and skills required to secure the justice your family deserves. At your convenience, you may contact our team by phone at (855) 452-5529 or by e-mail at firstname.lastname@example.org for a free, no-obligation case consultation. We are here to help you every step of the way.
 Nordeng, H. (2001) “Neonatal withdrawal syndrome after in utero exposure to selective serotonin reuptake inhibitors” Acta Pædiatr Vol. 90; pp. 288-291