Association of neonatal withdrawal syndrome with concurrent use of multiple neuropsychiatric medications in pregnant women

Abstract

Aim: Neonatal withdrawal syndrome is characterized by withdrawal symptoms in neonates because of the discontinuation of transplacental drug transfer after delivery. This study aimed to examine the risk factors for withdrawal symptoms to clarify the impact of the number of neuropsychiatric drugs administered during pregnancy. Methods: This was a retrospective observational study including 344 neonates born to 341 mothers receiving neuropsychiatric drugs, including antipsychotics, antidepressants, antiepileptics, and anxiolytics/sedatives during pregnancy. The presence of withdrawal symptoms was assessed using the Isobe score, comprising 15 symptoms. Multivariable logistic regression analysis was performed to identify significant risk factors for the presence of withdrawal symptoms. Results: Withdrawal symptoms developed in 178 (51.7 %) neonates. The frequency of neonates with withdrawal symptoms was higher in neonates born to mothers receiving ≥3 neuropsychiatric drugs compared to those born to mothers receiving 1–2 neuropsychiatric drugs (73.2 % vs. 45.0 %; P < 0.001). By multivariable logistic regression analysis, the presence of withdrawal symptoms was associated with the concurrent use of ≥3 neuropsychiatric drugs during pregnancy (adjusted odds ratio, 2.24; 95 % confidence interval, 1.09–4.62; P = 0.029) and the maternal use of antipsychotics (adjusted odds ratio, 1.77; 95 % confidence interval, 1.06–2.94; P = 0.028). Conclusions: The concurrent use of ≥3 neuropsychiatric drugs during pregnancy and the maternal use of antipsychotics were significant risk factors for the presence of withdrawal symptoms.