JMIR Publications

ABSTRACT

Background:

Up to 20% of mothers experience antenatal depression and approximately 30% of these women are treated with serotonergic psychotropic pharmacological therapy during pregnancy. Serotonergic antidepressants readily cross the placenta and the fetal blood-brain barrier, altering central synaptic 5HT signaling potentially altering 5HT levels in the developing fetal brain.

Objective:

Assess the impact of prenatal exposure to serotonergic antidepressants, accounting for maternal mood disturbances on markers of stress regulation during childhood.

Methods:

We will follow PRISMA guidelines and will search MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycINFO, and ClinicalTrials.gov for full-length studies that assessed physiological (i.e., cortisol level, heart rate variability, salivary amylase, pupillary size, C-reactive protein, etc.) indices of stress regulation children of pregnant people who were treated with a serotonergic antidepressant at any point during pregnancy. We will assess the quality of observational studies using the Newcastle-Ottawa Scale and the quality of experimental studies using the Cochrane Risk of Bias tool. When possible, we will conduct a random-effects meta-analysis. If meta-analysis is not possible, we will conduct a narrative review. If a sufficient number of studies are found, we will perform subgroup analysis and assess outcomes measured by drug class, dose, trimester of exposure, and child’s age and gender.

Results:

We registered our review protocol with PROSPERO (2021: 275750), completed the literature search, and initiated title and abstract review in August 2021. We expect to finalize this review by February 2022.

Conclusions:

Findings should identify the impact of prenatal antidepressant effects on stress regulation and distinguish the impact from prenatal exposure to maternal mood disturbances. This review should inform decisions about serotonergic antidepressant use during pregnancy.