1.0 Introduction
1.1 Background of Study
Sertraline has become one of the most frequently prescribed SSRIs for pregnant women owing to its efficacy and lower risk of drug interactions compared to other antidepressants (Gentile, 2011). Its usage during pregnancy, however, introduces ethical and medical concerns because of the potential exposure of the fetus to psychotropic medications during a sensitive developmental period. The ability of sertraline to cross the placental barrier means that the fetus is not insulated from its pharmacologic effects (Heikkinen et al., 2002).
Depression and anxiety disorders are among the most prevalent mental health challenges experienced by women of childbearing age. According to the World Health Organization (2023), approximately 10–20% of pregnant women globally experience some form of mental illness during pregnancy, with depression being the most common. As such, managing maternal mental health during pregnancy is essential for ensuring both maternal and fetal well-being. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) like sertraline, are often considered first-line pharmacologic treatments for moderate to severe cases of depression during pregnancy due to their relatively favorable safety profiles (Anderson et al., 2020).
Numerous observational studies and clinical reviews have examined the potential teratogenic risks of SSRIs, including sertraline, with mixed findings. While some research indicates no significant increase in the risk of major congenital anomalies, other studies suggest a slightly elevated risk of cardiac defects and neonatal complications such as respiratory distress, feeding difficulties, and jitteriness associated with neonatal adaptation syndrome (Reis & Källén, 2010; Moses-Kolko et al., 2005). The U.S. Food and Drug Administration has issued warnings regarding the use of SSRIs during late pregnancy due to the potential risk of persistent pulmonary hypertension of the newborn (PPHN), a rare but serious condition (Chambers et al., 2006).
According to Bauer et al. (2019), sertraline is a commonly prescribed antidepressant classified under selective serotonin reuptake inhibitors (SSRIs). It is primarily used in the management of major depressive disorder, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder (Bauer et al., 2019).
Sertraline works by increasing the levels of serotonin according to Preskorn (2020), a neurotransmitter that contributes to feelings of well-being and happiness, in the brain by inhibiting its reabsorption into neurons (Preskorn, 2020). During pregnancy, many women may continue to experience or even develop new-onset depression or anxiety disorders, which necessitate pharmacological interventions such as SSRIs to ensure both maternal and fetal well-being (Yonkers et al., 2009). The use of sertraline during pregnancy, however, raises concerns due to the potential risks it may pose to the developing fetus and newborn (Reis & Källén, 2010). The placenta does not act as a complete barrier to medications, including SSRIs like sertraline, meaning the fetus can be exposed to the drug during critical stages of development. Studies have shown that sertraline can cross the placental barrier and be detected in amniotic fluid and umbilical cord blood (Heikkinen et al., 2002).
Moses-Kolko et al. (2005) reported that, there is evidence indicating that newborns exposed to SSRIs in late pregnancy may exhibit symptoms of neonatal adaptation syndrome, including respiratory distress, irritability, feeding difficulties, and hypoglycemia (Moses-Kolko et al., 2005). Long-term effects on neurodevelopment have also been a topic of concern and study. While some research has suggested that prenatal exposure to SSRIs might influence motor and behavioral outcomes in children, the evidence remains inconclusive and confounded by factors such as maternal illness severity, genetics, and environmental influences (Gentile, 2015). Therefore, the decision to initiate or continue antidepressant treatment during pregnancy, particularly with drugs like sertraline, must involve a careful risk-benefit analysis, individualized treatment planning, and close monitoring by healthcare professionals.
1.2 Statement of Problems
Investigation revealed that there is lack of conclusive evidence regarding the safety of sertraline use during the various stages of pregnancy. The use of sertraline during pregnancy is raising significant concerns among healthcare professionals, expectant mothers, and researchers due to the delicate balance between treating maternal mental health disorders and protecting fetal development (Yonkers et al., 2009).
In addition, the emotional dilemma faced by expectant mothers who must choose between continuing their medication and worrying about the health of their unborn child is not adequately addressed in clinical practice. The lack of individualized treatment protocols that take into account both the psychological needs of the mother and the physiological safety of the baby is contributing to inconsistent care and outcomes across healthcare settings. Another pressing concern is that sertraline is crossing the placental barrier and reaching the fetus during critical periods of organ formation and neurological development (Heikkinen et al., 2002).
Furthermore, there is an ongoing debate about the association between in utero exposure to sertraline and long-term neurodevelopmental issues in children, such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Although some studies suggest these risks are minimal, the presence of underlying maternal mental health conditions and environmental factors is making it difficult to draw clear conclusions (Brown et al., 2017). It is against the backdrop that this study seeks to address these problems by exploring the effects of sertraline use during pregnancy on both the mother and the developing fetus.
1.3 Aim and Objectives of Study
The study aims to examine the use of sertraline during pregnancy and assess its potential effects on the fetus and newborn baby.
The specific objectives of the study are as follows:
- To investigate the association between prenatal exposure to sertraline and birth outcomes such as birth weight and gestational age.
- To evaluate the short-term effects of sertraline on neonates, including signs of adaptation syndrome.
- To examine potential long-term developmental effects on children exposed to sertraline in utero.
- To assess the prevalence of sertraline use among pregnant women.
- To provide clinical recommendations for safer antidepressant use during pregnancy.
1.4 Research Questions
Based on the objectives of the study, the following research questions have been formulated:
- What is the prevalence of sertraline use among pregnant women in the study area?
- What short-term effects are observed in newborns exposed to sertraline during pregnancy?
- Is there a significant relationship between sertraline use during pregnancy and birth outcomes such as low birth weight or premature delivery?
- What long-term developmental issues, if any, are linked to prenatal exposure to sertraline?
- What recommendations can be provided to guide the use of sertraline in pregnancy?
1.5 Significance of Study
The outcome of this research will assist policymakers in formulating or revising health regulations and guidelines that ensure safer maternal mental health care practices. In addition, this research will support pharmaceutical companies in evaluating the safety profiles of their products and guide future drug development.
Furthermore, the findings will guide pregnant women and their families in comprehending the possible effects of antidepressant use, empowering them to make informed choices. It will also inform policy development, leading to improved health guidelines and protocols for managing depression during pregnancy.
Lastly, the findings of this research will contribute to academic and medical literature, offering a foundation for future research and discussions around maternal mental health and prenatal pharmacology.
1.6 Scope of Study
The scope of the study is focused on evaluating the use of sertraline and its effects on pregnancy and neonatal health among pregnant women receiving antenatal care at Lagos University Teaching Hospital (LUTH), Lagos State, Nigeria. The study will include clinical data from mothers who have used sertraline before and during pregnancy and assess outcomes based on neonatal health records and follow-up interviews.
1.7 Limitations of the Study
Several limitations were encountered during the course of this study, which may have influenced the results and conclusions.
- Time Constraints: A study of this nature needs relatively long time during which information for accurate or at least near accurate inference could be drawn. The period of the study was short, time posed as constraints to the research.
- Financial Constraints: The research would have extended the survey to other area at the empirical level, but limitation as included cost of transportation to the source of material and the cost of time setting of the already completed work.
- Lack of Cooperation: Many of the respondents are usually aggressive on issue that border cooperation among the respondents border.
- Response Bias: The study will involve surveys and interviews with cooperative managers and members. Response bias may occur if respondents provide socially desirable answers or if there is reluctance to disclose negative financial information due to privacy concerns or fear of repercussions.
1.8 Definition of Terms
Sertraline: A selective serotonin reuptake inhibitor (SSRI) used to treat depression, anxiety, and other mood disorders by increasing serotonin levels in the brain (Preskorn, 2020).
Pregnancy: A physiological state in women during which one or more embryos develop in the uterus, typically lasting about 40 weeks (WHO, 2023).
Neonatal Adaptation Syndrome: A collection of symptoms observed in newborns exposed to SSRIs in utero, such as jitteriness, irritability, respiratory distress, and feeding issues (Moses-Kolko et al., 2005).
Placental Transfer: The process by which substances like medications are passed from the maternal bloodstream through the placenta to the fetus (Heikkinen et al., 2002).
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