Neonatal convulsions and subarachnoid hemorrhage after in utero exposure to paroxetine

• Published in: Revista de neurologiá Vol. 36; no. 8; p. 724
• Main Authors: Salvia-Roigés, M D, Garcia, Ll, Goncé-Mellgren, A, Esqué-Ruiz, M T, Figueras-Aloy, J, Carbonell-Estrany, X
• Format: Journal Article
• Language: Spanish
• Published: Spain 16-04-2003
• Subjects: Adult; Female; Humans; Infant, Newborn; Paroxetine - adverse effects; Pregnancy; Pregnancy Trimester, Third; Seizures - chemically induced; Serotonin Uptake Inhibitors - adverse effects; Subarachnoid Hemorrhage - chemically induced
• ISSN: 0210-0010
• DOI: 10.33588/rn.3608.2002521

Selective serotonin reuptake inhibitors (SSRIs) are often used as antidepressants in pregnant women. SSRIs do not appear to increase the teratogenic risk when used in their recommended doses. However, not enough information is available at this time about the risk of toxicity and complications in newborns, after mother treatment with SSRI during the third trimester of pregnancy. We are limited to the existing reports that describe newborns with symptoms due to hyperserotoninemia or withdrawal.
One newborn whose mother had been treated with paroxetine 20 mg/day during pregnancy, presented convulsions and subarachnoid haemorrhage in the first six hours of life. The newborn did not present symptoms of hypoxic ischaemic encephalopathy, withdrawal syndrome, infection, metabolic alterations, cerebral malformations or coagulopaties.
The most probable etiology is that the paroxetine could decrease the seizure threshold, taking place the first seizure during delivery. The difficult fetal extraction would have provoked the subarachnoid haemorrhage in a patient with an impaired haemostatic function due to a depletion of platelet serotonin and may also contribute the increased vascular fragility due to paroxetine and reported in adults or in animals.
Neonatal convulsions and subarachnoid haemorrhage may occur after paroxetine treatment in the third trimester of pregnancy. An accurate follow up of these newborns in the firsts days of life is strongly recommended.