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Maternal mental health and depression should be of significant interest to the NIPE practitioner. The use of psychotropic drugs can affect the newborn in relation to withdrawal symptoms (Wang 2010; NICE 2018a; NICE 2018b). In comparison to withdrawal behaviours in the newborn from illicit substances, the effects from antidepressant medication, particularly the selective serotonin reuptake inhibitors (SSRIs), are perhaps better defined (Sanz et al. 2005; Wang 2010, NICE 2018b). This is very helpful to the NIPE practitioner who is perhaps unsure of the significance of such drugs taken during pregnancy. The following list outlines some associations with the use of antidepressant drug groups:

SSRIs:

 Risk of fetal cardiac anomalies has not been confirmed – conflicting evidence.

 Increased risk of persistent pulmonary hypertension after 20 weeks of gestation.

 Risk of transient neonatal withdrawal syndrome can affect newborns exposed to SSRIs in the weeks preceding birth, causing central nervous system, motor, respiratory and gastrointestinal symptoms (NICE 2018c).

Tricyclic antidepressants (TCAs):

 Limited evidence to suggest that TCAs are associated with an overall increased risk of congenital malformation.

 Neonatal withdrawal symptoms may be associated with TCA use in pregnancy.

Adapted from NICE (2018b).

The NIPE practitioner must firstly establish when the mother commenced the medication and, secondly, check if the mother is still taking medication. There is an associated risk to the mother if she has abruptly stopped taking the medication at any point without seeking medical advice. This is particularly relevant in the immediate postnatal period and may predispose her to active postnatal depression. If the mother is still taking medication, then the newborn must have a thorough neurological examination. There is some debate as to whether withdrawal from antidepressant medication in the newborn is more of a toxicity reaction (Wang 2010) to the drug as opposed to active drug withdrawal, which would increase the severity and prolong the severity of the symptoms.

Maternity services may have local guidelines in place for postnatal observation on newborns of mothers who have been prescribed antidepressant medication in pregnancy, particularly during the latter stages.

The NIPE practitioner can observe the behavioural interactions between a mother and her newborn at the time of the newborn examination. Any concerns about abnormal attachment behaviour must be relayed to the midwife caring for the mother and newborn, in the first instance. The level of concern may necessitate the activation of the safeguarding pathway. Further information about mental health in pregnancy can be found at https://www.nice.org.uk/guidance/cg192/evidence/full‐guideline‐pdf‐4840896925.