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Maternal Antidepressant Use and Autism Risk
JAMA; 2017 Apr 18; Brown, Ray, et al/JAMA; 2017 Apr 18; Sujan, Rickert, et al
Maternal antidepressant use during pregnancy was not associated with autism spectrum disorder (ASD) in the child, according to a pair of recent studies.
The first study examined the association between serotonergic antidepressant use during pregnancy and ASD in children in 35,906 singleton births at a mean gestational age of 38.7 weeks with median follow-up of 4.95 years. In the 2,837 pregnancies (7.9%) exposed to antidepressants, only 2.0% of children were diagnosed with ASD.
The second study was a retrospective cohort study off offspring born between 1996 and 2012 and followed up through 2012 that examined associations of maternal antidepressant use during the first trimester of pregnancy with preterm birth, small for gestational age, ASD, and attention-deficit/hyperactivity disorder in offspring. Among 1,580,629 offspring born to 943,776 mothers, 5.38% of exposed vs 2.14% of unexposed to antidepressants were diagnosed with ASD by age 15 years. At the population level, first-trimester exposure was associated with outcomes compared with unexposed offspring; however, when including a model that looked at unexposed siblings and adjusted for pregnancy, maternal, and paternal traits, first-trimester antidepressant exposure was associated with preterm birth (OR, 1.34 ), but not with small for gestational age, autism spectrum disorder, or attention-deficit/hyperactivity disorder.
Brown HK, Ray JG, Wilton AS, Lunsky Y, Gomes T, Vigod SN. Association between serotonergic antidepressant use during pregnancy and autism spectrum disorder in children. JAMA. 2017;317(15):1544-1552. doi:10.1001/jama.2017.3415.
Sujan AC, Rickert ME, Öberg AS. Associations of maternal antidepressant use during the first trimester of pregnancy with preterm birth, small for gestational age, autism spectrum disorder, and attention-deficit/hyperactivity disorder in offspring. JAMA. 2017;317(15):1553-1562. doi:10.1001/jama.2017.3413.
These studies illustrate the challenge of investigating antidepressant use and pregnancy outcomes. Since behavioral conditions may be influenced by genetics, environment, and medication exposure, it is important to control for hereditary influences and antidepressant exposure when looking at associations between antidepressants and their effect on offspring. The above data illustrates this: an association between maternal antidepressant use was seen in the unadjusted data, but when adjusted for familial behavioral issues, there was no relationship between maternal antidepressant use and pregnancy outcomes. Depression in pregnancy has its own adverse effects on the child, and it is reassuring to see that antidepressants do not seem to cause autism spectrum disorder. —Neil Skolnik, MD