Use of SSRI in pregnancy: Consequences for motor and cognitive development of the child.

Infants of depressed mothers are at increased risk for developing cognitive and
motor problems. A major depression often is treated with drugs, also in
pregnant women, although the risk of the drug for the fetus is unknown.
Approximately 2% of the Dutch pregnant women is using an SSRI (selective
serotonin reuptake inhibitor) as antidepressant drug.
SSRI*s cross the placenta easily. The consequences of the use of an SSRI by the
mother for the child remain to be determined. Short-term consequences are,
among other things, an increased incidence of birth defects, withdrawal
symptoms, convulsions, low Apgar score, low birth weight, prematurity, and
admission to a neonatal intensive care unit. Long-term effects are
insufficiently examined.
Neurotransmitters, especially the ontogenetic *old *ones like serotonin, are
detectable in the embryo before the neurons are differentiated. Serotonin is
present in the fertilized egg and is involved in the morphogenesis of brain,
heart, craniofacial epithelium and other structures. In MAO- knockout mice in
which an excessive amount of serotonin is present, normal development of the
somatosensor cortex is absent. Both a deficiency as well as an excessive amount
of serotonin changes the amount and development of neurons in the brain.
Hypothesis: Regarding the facts that serotonin is involved in synthesis of
serotonergic neurons (autoregulation) as well as in the development of target
tissues such as specific parts of the brain, the use of SSRI in pregnancy could
lead to problems in the development of the fetus, both structurally as in the
case of morphogenesis, and in motor and cognitive development.

The objective of this study is to examine the consequences of the use of an
SSRI in pregnancy for motor and cognitive development of the child, in the
short and long term.

A prospective controlled design.

The tests at the age of 1 week and 3 months concern the observation of
spontaneous movements and carry no burden for the child.
The test at the age of 2 years can be judged as a play situation in which the
child is invited to show certain skills.
The tests at the age of 6 years are divers and can easily be performed by
children of this age.
This research can only be performed with children because it concerns the
development of children. These tests carry no risks for the child.