PHARMACOGENETICS AND THE NEONATAL ABSTINENCE SYNDROME FOLLOWING MATERNAL ANTIDEPRESSANT USE IN PREGNANCY

Objectives Depression and anxiety are common, occurring in up to 20% of pregnancies. Many women will be treated with antidepressant medication during pregnancy, but there is ongoing concern about possible withdrawal effects in the newborn, referred to as the Neonatal Abstinence Syndrome (NAS). The reason why some infants remain resilient while other are affected has not been elucidated. The objective of this study was to examine whether genetic differences in drug metabolism influence the NAS. Methods Women who took serotonin reuptake inhibitor medications during pregnancy were recruited from obstetrical clinics at Mount Sinai Hospital from August 2015-August 2017. Participants provided a saliva sample for genetic analyses of cytochrome P450 enzyme polymorphisms and completed questionnaires to rate their symptoms of depression and anxiety. Delivery and NAS data were collected from the electronic medical record. Results Ninety-one women met the inclusion criteria. The mean gestational age at delivery was 38.3 weeks and the mean birthweight was 3.1kg. Only a small proportion (2%) of exposed neonates exhibited severe NAS (score of ? 8); mild NAS was seen in 12 neonates (13%; ? 4 on two occasions). 30% of the exposed neonates whose mothers had decreased enzyme activity had NAS versus 14%, although this did not reach significance (p=0.15). Conclusions The majority of exposed neonates did not show NAS. Of those that showed NAS, maternal pharmacogenetics may have influenced the exposure to medication in utero among some infants, thereby influencing withdrawal effects. These data may provide some reassurance for women who require these medications during pregnancy for mood or anxiety disorders.