Abstract
Prenatal selective serotonin reuptake inhibitor (SSRI) exposure increases the risk for adverse neonatal behavioral outcomes; although it is unknown whether altered brain function is present before birth. We investigated fetal vascular and heart rate changes at 36-wk gestation in SSRI-treated women with mood disorders (n = 29) [exposed (EXP)] and controls (n = 45) [non-EXP (NEXP)]. Fetal middle cerebral artery (MCA) flow parameters and heart rate characteristics were obtained during pre-SSRI dose morning and postdose afternoon sessions. Maternal mood and cord Hb and hematocrit were measured. Basal fetal heart rate (fHR) did not differ between groups or across the day. The fHR short- and long-term variations, accelerations, and duration of high variability episodes remained lower and did not change across the day in EXP, whereas all increased significantly in NEXP. In both groups, MCA flow velocity and volume flow increased significantly across the day. EXP MCA pulsatility index was significantly lower, as was MCA cross-sectional area. EXP cord Hb and hematocrit were significantly increased. Prenatal SSRI exposure reduced fetal MCA flow resistance and fHR variability, before and after an SSRI dose, controlling for maternal mood. These changes and the SSRI-related increased red cell indices suggest possible fetal hypoxia.
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Abbreviations
- ANCOVA:
-
analysis of covariance
- EXP:
-
exposed
- NEXP:
-
nonexposed
- fHR:
-
fetal heart rate
- HAM-A:
-
Hamilton Rating Scale for Anxiety
- HAM-D:
-
Hamilton Rating Scale for Depression
- MCA:
-
middle cerebral artery
- PI:
-
pulsatility index
- REM:
-
rapid eye movement
- SSRI:
-
selective serotonin reuptake inhibitor
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Acknowledgements
We thank the mothers and their infants who participated and contributed to this work, as well as Mary Beckingham, Kiran Greywall, and Wendy Frasca for their contributions in organizing and facilitating this research program. We thank Shelley Soanes and Bruce Duncan for their assistance during the study sessions. We also acknowledge the contribution of our statistical consultant, Dr. Michael Papsdorf.
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Supported by the Canadian Institutes of Health Research [T.F.O., CIHR #MOP 57837]; HELP (Human Early Learning Partnership), Senior Career Award and is the R. Howard Webster Professorship in Child Development (UBC, College of Interdisciplinary Studies) [T.F.O.]; and Investigatorship Award from the Child & Family Research Institute [D.R.].
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Rurak, D., Lim, K., Sanders, A. et al. Third Trimester Fetal Heart Rate and Doppler Middle Cerebral Artery Blood Flow Velocity Characteristics During Prenatal Selective Serotonin Reuptake Inhibitor Exposure. Pediatr Res 70, 96–101 (2011). https://doi.org/10.1203/PDR.0b013e31821ba11a
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DOI: https://doi.org/10.1203/PDR.0b013e31821ba11a
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