Effects of Prenatal Exposure to Psychotropic Drugs on Newborns

"This study investigated the effect of psychotropic medication use during pregnancy on short-term neonatal outcomes, focusing on the implications of non-opioid psychotropic polypharmacy and co-exposure. The incidence of adverse events was not clearly increased in newborns exposed to one or two maternal psychotropic medications compared to unexposed infants. However, in cases involving maternal use of three or more psychotropic medications, a higher frequency of short-term respiratory support and NAS-related symptoms was observed, although the number of such cases was limited. We also found no consistent trends linking maternal psychiatric diagnoses to their medications and neonatal adverse outcomes. Moreover, psychotropic drugs that inhibit CYP2D6 worsened short-term neonatal outcomes in cases of multiple psychotropic medications.

"This study found that taking three or more psychotropic medications during pregnancy worsened short-term outcomes in full-term singleton newborns. Numerous studies have investigated the effects of in utero exposure to individual psychotropic medications on obstetric and neonatal outcomes2,3,7,18,19. However, limited research has examined the impact of psychotropic polypharmacy during pregnancy on neonatal or obstetric outcomes, specifically regarding co-exposure or the number of psychotropic medications used8,9,10. Huybrechts et al. reported that in utero exposure to two or more psychotropic medications with opioids doubled the risk of NAS9. They observed that NAS severity was higher in neonates exposed to both opioids and psychotropic drugs compared to those exposed only to opioids. However, their study did not examine neonatal adverse effects beyond NAS or the outcomes of in utero psychotropic polypharmacy without opioid exposure9. As previous studies investigating the effects of non-opioid medication during pregnancy, Sadowski et al. reported higher NICU admission rates in neonates exposed to polytherapy compared to monotherapy (29% vs. 16%) when analyzing second-generation antipsychotics with other psychotropic medications, though this difference was not statistically significant8. Frayne et al. also found higher NICU admission rates in newborns of women with severe mental illness on psychotropic medications but no significant difference between the monotherapy and polytherapy groups for those on antidepressants or antipsychotics10. In addition to these evidences8,10, our study identified infants exposed to three or more non-opioid psychotropic drugs during pregnancy as a high-risk population. As untreated maternal mental health problems pose significant risks, the decision to use psychotropic medications during pregnancy should be made on an individual basis after a thorough risk/benefit analysis. The adverse effects of prenatal exposure to psychotropic drugs on newborns must be balanced against the benefits of mental health treatment for both the mother and infant20. Appropriate neonatal care should be prioritized for infants exposed to three or more psychotropic drugs during pregnancy."