Table 2.

Studies on short-term effects

Author, kind of study, scale used to assess depression, and severity	Number of participants	Number of babies assessed	Age of the baby at assessment	Timing of mother exposure	Treatment used	NBAS results	Finding
Ferreira et al. 2007, Canada Retrospective cohort study Scale used and severity not specified.	76 exposed on SSRI or venlafaxine; 90 control	79 exposed to SSRI or venlafaxine; 91 control	At birth	Third trimester	SSRI (paroxetine, fluoxetine, sertraline, citalopram, fluvoxamine) venlafaxine.	All neonatal behavioral signs (tremors, shaking, agitation, spasms, hypertonia or hypotonia, apnea, tachypnea, bradycardia, indrawing, irritability, and sleep disturbances): group 1 = 59 (77.6) group 2 = 37 (41.1) (p < 0.001)	Significant differences between newborns exposed and control for NBAS, prematurity, and birth weight. Neonatal behavioral signs were frequent in exposed newborns, but symptoms were transient and self-limited. Premature infants could be more susceptible to the effects of SSRI and venlafaxine.
Zeskind and Stephens 2004, USA Prospective cohort study Review of medical records Severity not specified.	17 exposed to SSRI; 17 control	17 exposed to SSRI; 17 control	At birth	All pregnancy	SSRI (paroxetine, fluoxetine, sertraline, citalopram) and bupropion	Significant differences between groups in a wide range of neurobehavioral outcomes (tremulousness, behavioral states, active sleep)	Significant differences between newborns exposed and control for NBAS and prematurity. Results provide the first systematic evidence that women who use SSRIs during pregnancy have healthy, full-birth-weight newborn infants who show disruptions in a wide range of neurobehavioral outcomes.
Rampono et al., 2009 USA Prospective observational study Edinburgh Postnatal Depression Scale (EPDS) >11	38 exposed to antidepressant (27 SSRI, 11 SNRI), 18 control	38 exposed to antidepressant (27 SSRI, 11 SNRI), 18 control	Between 1 and 6 days	Any time throughout pregnancy, trimester is not specified	SSRI (escitalopram, paroxetine, fluoxetine, sertraline, citalopram, fluvoxamine) venlafaxine.	Significant differences in mean NBAS scores between cases and controls for the habituation, social-interactive, motor, and autonomic clusters were found (p < 0.05).	Significant differences between newborns exposed and control in same NBAS scores in the early perinatal period but these were self-limiting and similar for both SSRIs and the SNRI venlafaxine.
Suri et al., 2011 USA Prospective, naturalistic, blinded study SCID-I for DSM-IV, Hamilton Depression Rating Scale (HDRS) Maximum HDRS score across pregnancy: 18.5/16.4/10.7	33 exposed to antidepressant, 16 with a history of MDD not treated during pregnancy, 15 control	31 exposed to antidepressant, 14 whose mothers had a history of MDD not treated during pregnancy, 14 control	First visit: within 1 week; 2nd visit between 6 and 8 weeks	All women took AD for the 2nd and 3rd trimester, majority for all trimester.	Antidepressant (not specified)	Summary scores for the 7 clusters were not significantly different among groups at either visit 1 or visit 2. Some significant differences were noted on rapidity of buildup item at visit 1, inanimate auditory and defense items at visit 2 but after Bonferroni correction none significant differences.	No significant differences in summary scores of the NBAS among the three study groups. Use of antidepressants in pregnancy was not associated with significant neurobehavioral effects in infants.
Field et al., 2009, USA Randomized clinical trial SCID-I for DSM-IV, Center for Epidemiological Studies-Depression (CES-D): 23.7/20.3	88 massage group, 61 untreated depressed (standard treatment)	88 massage group, 61 untreated depressed (standard treatment)	At birth	Second and third trimester (20–32 weeks)	12 weeks massage therapy (twice per week)	The massage group neonates received significant higher scores on habituation, orientation, motor, and depression scores. In addition, they had lower cortisol levels.	Significant differences between newborns of depressed mothers treated with massage therapy and untreated for NBAS, prematurity, low birth weight, and they had lower cortisol levels. The group of treated women reduced depression scores by the end of the therapy period and cortisol levels during the postpartum period.
Field et al., 2004, USA Randomized clinical trial Profile of Mood States Scale (POMS), CES-D: 24.9/26.2/28.3/6.5	84 depressed women divided in three groups: 28, massage therapy; 28, muscle relaxation; 28, standard prenatal care; 28 control	84 depressed women divided in three groups: 28, massage therapy; 28, muscle relaxation; 28, standard prenatal care; 28 control	Within a few days after birth	Second and third trimester	16 weeks massage therapy (twice per week)	Significant difference in habituation, range of state, state, autonomic stability, withdrawal, depressed, motor maturity.	Significant better NBAS score for the mother’s baby treated with massage therapy.
Smith et al. 2013 USA Prospective study Composite International Diagnostic Interview v2.1 (CIDI), EPDS: 7.67/5.18	6 exposed to SSRI, 61 control	5 exposed to SSRI, 41 control	24 h age (±8 h)	At least more than 1 month during the third trimester	SSRI (fluoxetine, citalopram, sertraline)	Significant difference in motor cluster scores: 25.2/28.9 (S). No other significant differences.	Significant differences between newborns exposed to SSRI and control mothers, the former had poorer motor development at NBAS, lower 5-min APGAR scores, and shorter mean gestational age as compared to unexposed infants. No significant differences in infant sleep state and number of startless and tremulousness.
Salisbury et al. 2011 USA Prospective, naturalistic cohort study SCID-I for DSM-IV, RSD: 3.8/13.5/12	76 control, 7 depressed untreated, 46 depressed treated	56 control, 20 depressed untreated, 36 depressed treated	Between 1 and 21 days	At least four consecutive weeks during the second and/or third trimesters of this pregnancy.	SSRI	NICU Network Neurobehavioral Scale (NNNS); MDD group infants had lower attention scores compared to CON group infants and MDD + SRI group infants (S). MDD + SRI group infants had lower quality of movement scores and more CNS stress signs than infants in the CON groups (S). Hypertonicity and arousal were significant in the overall model.	Newborns exposed to maternal depression and SSRI treatment during pregnancy had higher risks of different neurobehavioral profiles than control group in the first month of life.