636 - Neonatal Outcomes in Term Infants with Maternal Selective Serotonin Reuptake Inhibitor Use: A Retrospective Chart Review Before, During, and After the COVID-19 Pandemic

Publication Number: 4622.636

Carlie G. Gatlin, Children's Mercy Hospital, Olathe, KS, United States; Megan Tucker, Children's Mercy Hospitals and Clinics, Fairway, KS, United States; Angela M. Bolton, Children's Mercy Hospitals and Clinics, Lenexa, KS, United States; Mary Anne Kucera, Children's Mercy Hospitals and Clinics, prairie village, KS, United States; Deanna McPherson, Children's Mercy Hospitals and Clinics, Lees Summit, MO, United States; Kerry e. Kohrs, Children's Mercy Hospitals and Clinics, Lees Summit, MO, United States; Staci S. Elliott, Children's Mercy Hospitals and Clinics, Overland Park, KS, United States; Hung-Wen Yeh, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Venkatesh Sampath, Children's Mercy Kansas City, kansas city, KS, United States

Background: Maternal antenatal selective serotonin reuptake inhibitor (SSRI) use has been suggested as a risk factor for neonatal complications, though evidence remains inconclusive. Mental health conditions increased during the COVID-19 pandemic, raising questions about SSRI prescription trends. This study examines associations between maternal SSRI use and neonatal outcomes across three time periods: before, during, and after the pandemic.

Objective: Primary: Determine if SSRI use in pregnancy is associated with NICU admission, respiratory support, hospital stay length, hypoglycemia, formula feeding, and/or delivery room resuscitation. Secondary: Assess SSRI prescription prevalence across pandemic phases.

Design/Methods: Retrospective chart review of term maternal-infant dyads born in Jan/June during each of the years of 2019-2022 in a level III NICU. Data included maternal demographics, SSRI use, comorbidities, and neonatal outcomes. Exclusions: congenital anomalies, multiple gestations, and preterm birth < 37 weeks. N=1,246. Categorical variables were compared using Chi-squared or Fisher's exact test; continuous variables via Wilcoxon or Kruskal-Wallis tests. Regression models adjusted for COVID phase and covariates. Missing data (>5%) were imputed using MICE and random forest, with pooled results via Rubin's rule.

Results: Maternal SSRI use rates did not differ significantly across the 3 time periods (pre-Covid 54/572 9.5% vs. during Covid 31/338 9.3% vs. post-Covid 36/336 11%) (Table 1). SSRI use was highest among those with pre-pregnancy use (p= < 0.001), and white mothers (White 108/890 12% vs. Non-white 13/354 3.7 %, p= < 0.001) (Table 2). Infants exposed to SSRIs were more likely to require delivery room resuscitation (OR 2.51, 95% CI 1.19-5.26, p= 0.015) (Table 3B). Mothers using SSRIs were more likely to formula or combo feed rather than exclusively breastfeed (OR 2.86, 95% 1.68-4.85, p=0.000) (OR 1.91, 95% 1.05-3.47, p= 0.034) (Table 3F). No significant associations were found between maternal SSRI use and neonatal hypoglycemia, NICU admission, respiratory support, or length of stay (Table 3A,C,D,E).

Conclusion(s): In our study, we did not find an increase in maternal SSRI use during the COVID pandemic. Maternal SSRI use was associated with increased delivery room resuscitation and non-exclusive breastfeeding, but no other adverse neonatal outcomes. These findings highlight the continued concerns of maternal SSRI use on neonatal outcomes, and advocate for careful consideration and discussion of its benefits vs. risks in pregnant mothers as expressed by recent FDA and ACOG statements.

Table 1: Patient Characteristics
Maternal/Infant dyad characteristics by Covid-19 phase.

Table 2: Maternal SSRI Use by Race
Prior maternal SSRI use by race and maternal SSRI use in pregnancy by race.

Table 3: Neonatal Outcomes
A) NICU admission B) Delivery room resuscitation C) Presence of hypoglycemia D) Time to discharge E) Postnatal respiratory support need F) Discharge diet

SSRI_preg= maternal SSRI use in pregnancy
Time to discharge was imputed in whole days