Maternal SSRI Use and Autism

Peter Forster Physical Conditions and Health, Treatments of Depression

The CBS Evening News (4/18, story 9, 1:15, Pelley) reported, “Studies have shown that pregnant women who take antidepressants are more likely to have children with autism.” Newly published studies examine whether the medication is causing this.

TIME (4/18, Park) reports that in two studies, investigators “found that other factors, including genes linked to mental illness, may be more strongly associated with autism than exposure to antidepressants.” One study “analyzed data from more than 1.5 million children whose mothers reported on whether they used antidepressants during pregnancy,” while the other study examined “more than 35,000 births and also compared rates of autism among brothers and sisters whose mothers used antidepressants during some pregnancies but not others.” The studies were both published April 18 in the Journal of the American Medical Association.

An editorial in the journal outlines the findings of the two studies:

Two studies in this issue of JAMA attempt to disentangle 2 of these mechanisms by using sophisticated statistical methods to adjust for possible measured and unmeasured confounding factors related to gestational antidepressant medication exposure and neurodevelopmental risks during childhood. Using large, population-level data registries from Sweden, Sujan et al examined associations between first trimester antidepressant exposure and neurodevelopmental outcomes such as autism spectrum disorder and attention-deficit/hyperactivity disorder in 1 580 629 offspring, accounting for family, timing of exposure, and paternal factors. First trimester maternal antidepressant use was associated with a small increased risk of preterm birth, but not with risk for adverse neurodevelopmental outcomes. In a discordant siblings analysis, the cumulative risk of autism spectrum disorder was 5.5% for exposed children and 4.6% for unexposed siblings (hazard ratio, 0.8 [95% CI, 0.6-1.1]), presumably reflecting that genetic and shared familial environmental factors account for the association demonstrated previously.

In another report in this issue of JAMA, Brown et al reported a lack of increased risk for autism spectrum disorder among children with serotonergic antidepressant exposure based on data from Ontario, Canada, among 35 906 singleton births to mothers receiving public prescription drug coverage. Autism spectrum disorder incidence was not statistically significantly different between exposed and unexposed siblings (3.40 vs 2.05 per 1000 person-years, respectively; adjusted hazard ratio, 1.60 [95% CI, 0.69-3.74]). An important methodological extension in this study was the use of a high-dimensional propensity score to adjust for 500 covariates that might collectively contribute to confounding. Together these 2 new studies add to a growing literature suggesting that the association between prenatal antidepressant medication exposure and autism spectrum disorder may not be causal. These data should reassure both parents and clinicians.

Maternal depression by itself seems to be associated with an increased risk of psychiatric problems in children, but, aside from a modest increase in premature births, this evidence suggests that the risk is not due to the treatment of depression.

For More Information

Pregnancy Related Mental Health Information

Pregnancy and Mental Health

References

Oberlander TF, Zwaigenbaum L. Disentangling Maternal Depression and Antidepressant Use During Pregnancy as Risks for Autism in Children. JAMA. 2017;317(15):1533-1534. doi:10.1001/jama.2017.3414

King BH. Association Between Maternal Use of SSRI Medications and Autism in Their Children. JAMA. 2017;317(15):1568-1569. doi:10.1001/jama.2016.20614

Sujan AC, Rickert ME, Öberg AS, et al. 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. doi:10.1001/jama.2017.3413

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. doi:10.1001/jama.2017.3415

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