The impact of the number of non-opioid psychotropic medications and their co-exposures during pregnancy on short-term outcomes in full-term neonates

Abstract

Abstract This study aimed to evaluate the impact of the number of psychotropic medications on short-term neonatal outcomes in pregnancies complicated by maternal psychiatric disorders, focusing on the effect of non-opioid psychotropic polypharmacy and co-exposure. A retrospective study was conducted on pregnancies complicated by maternal mental disorders that resulted in full-term singleton deliveries at a tertiary perinatal hospital between 2019 and 2023. Among 4,367 deliveries during the study period, 358 were identified. Pregnant women prescribed three or more psychotropic medications had significantly higher rates of adverse neonatal outcomes. Significantly, most infants exhibiting neonatal abstinence syndrome (NAS)-related symptoms were exposed in utero to selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines (BZs). Furthermore, neonates exposed to CYP2D6-inhibiting psychotropic drugs had significantly lower Apgar scores and higher rates of neonatal intensive care unit admission, respiratory ventilator use, and NAS compared to those not exposed to such drugs. Full-term neonates born to women with mental illness taking three or more psychotropic drugs were significantly more likely to experience adverse short-term outcomes. Particular attention should be given to neonatal adaptation in infants exposed in utero to CYP2D6-inhibiting psychotropic drugs, as well as SSRIs and BZs, especially in cases of multiple psychotropic medications.

Keywords

• Psychotropic medication
• Pregnancy
• Respiratory ventilator treatment
• Neonatal abstinence syndrome
• Cytochrome P450 2D6