Antidepressant use in pregnancy linked to psychiatric disorder in children

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Antidepressant use in pregnancy linked to psychiatric disorder in children

Antidepressant use during pregnancy is associated with increased risk of psychiatric disorder diagnosis in children, finds a study published in The BMJ today.

However, the researchers stress that this finding should be interpreted with caution as the association may be due to the mother’s underlying illness combined with antidepressant exposure in the womb.

Depression is common in women of childbearing age, and antidepressants have been increasingly used during pregnancy in the past few decades, with approximately 2-8% of pregnant women receiving this treatment.

Several studies have investigated whether the use of one type of antidepressant medication (selective serotonin reuptake inhibitor or SSRIs) during pregnancy is associated with autism spectrum disorder in offspring, although results have been conflicting.

Researchers have previously thought that SSRIs cross the placental barrier and affect the development of a baby’s brain.

If this holds true, exposure to SSRIs and other classes of antidepressants in the womb (in utero) may increase risk for a wider range of psychiatric disorders besides autism spectrum disorder.

So researchers investigate the association between in utero exposure to antidepressants and risk of psychiatric disorders.

The researchers analyzed data from 905,383 children born between 1998 and 2012 in Denmark and followed up for a maximum of 16.5 years.

Children were categorized into four groups according to mothers’ antidepressant use within two years before and during pregnancy: unexposed, antidepressant discontinuation (use before but not during pregnancy), antidepressant continuation (use both before and during pregnancy), and new user (use only during pregnancy).

Overall, psychiatric disorders were diagnosed in 32,400 children. The authors found that the 15-year risk of a psychiatric diagnosis in children was 8% when their mothers had not been exposed to antidepressants at all.

After adjusting for several potentially influencing factors, the researchers found a small increased risk for psychiatric disorders among children of mothers who used antidepressants before and/or during pregnancy (11.5% and 13.6%).

They also observed an increased risk of psychiatric disorders in children whose mothers continued antidepressant use during pregnancy (14.5%).

Results remained largely unchanged after further sensitivity analyses.

This is an observational study, so no firm conclusions can be drawn about cause and effect, and the authors outline some study limitations which could have introduced bias. However, strengths include the large sample size and the long follow-up period.

The researchers acknowledge that the decision to discontinue or maintain antidepressant treatment during pregnancy is challenging, and say any final decision on antidepressant continuation “should be individualised and made jointly by health professionals and patients.”

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News source: British Medical Journal. The content is edited for length and style purposes.
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