Taking antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), during pregnancy increases the risk that the mother’s child will later be diagnosed with an autism spectrum disorder (ASD), suggested research in JAMA Pediatrics.
Takoua Boukhris, MSc, of the University of Montréal in Québec, and colleagues used registry data to examine outcomes of 125 456 singleton full-term infants born from January 1998 to December 2009 in Québec. An average follow-up of 6 years revealed 0.72% of the cohort had been diagnosed with ASD at least once.
This prevalence is lower than recent estimates of 1%, noted Bryan H. King, MD, MBA, a psychiatrist at Seattle Children’s Hospital, in an accompanying editorial. The sample’s exclusion of premature births, however, “may also have lowered the overall prevalence of ASD, as preterm birth appears to contribute to the risk of ASD,” Dr King wrote.
Among the 3.2% of infants exposed prenatally to antidepressants, 88.9% were exposed in the first trimester and 53.6% were exposed in the second and/or third trimester. The prevalence of ASD among these children was 1% for first-trimester exposure and 1.2% for second- and/or third-trimester exposure.
After accounting for maternal sociodemographic characteristics, infant characteristics, and a maternal history of psychiatric and chronic physical conditions, women who took any antidepressant during the second and/or third trimester were 87% more likely to have a child diagnosed with autism than those who did not take antidepressants during pregnancy. That risk dropped to 75% in an analysis of only the women with a history of depression.
Women taking SSRIs during the second and/or third trimester were approximately twice as likely, after considering confounders, to have their child diagnosed with autism. Using more than one class of antidepressants more than quadrupled the risk of ASD in the child, based on 5 exposed infants, but no other drug classes showed a significant association with ASD diagnosis.
Dr King’s commentary pointed out the challenge of uncoupling depression as an independent risk factor from its treatment in assessing factors that might increase ASD risk, but he pointed to the differential risk between SSRIs and other drug classes as possible evidence of a true drug effect.
“But this finding must also be viewed in the context of other risks,” he wrote, noting other complications associated with untreated maternal depression. “It makes no more sense to suggest that antidepressants should always be avoided than to say that they should never be stopped,” he wrote.