Antidepressant Use During Pregnancy Not Linked to Intellectual Disability

Intellectual disability might be associated with other factors such as parental age and the mother's psychiatric disorders.

There is no association between intellectual disability (ID) and maternal use of antidepressants during pregnancy, according to a study published in JAMA Psychiatry.

Instead, the article, written by Alexander Viktorin, PhD, of Icahn School of Medicine at Mount Sinai in New York, New York, and colleagues attributed the association to a mechanism tied to such other factors as parental age and the mother’s psychiatric disorders.

In this population-based cohort study, the researchers examined 179,007 children (51.5% male; mean age at follow up: 7.9±0.6) with complete parental information born between January 1, 2006 and December 31, 2007. Both maternal and paternal psychiatric diagnoses were also included to adjust for confounding variables.

The researchers aimed to identify a connection between maternal antidepressant use during pregnancy and ID in offspring, along with the role that parental mental illnesses may play (the cohort included 3982 children [2.2%] born to mothers with at least 2 dispensation periods that overlapped the pregnancy [single dispensations were analyzed separately because of uncertainty of exposure]).

The investigators found that 37 (0.9%) of children exposed to antidepressants had an intellectual disability, compared with 819 (0.5%) of children who were unexposed. Relative risk (RR) of ID for the full population sample was 1.33 (1.64 in a subsample analysis of mothers with depression). There was no clear relationship with disability in children with mothers who used non-selective serotonin reuptake inhibitor (SSRI) antidepressants (adjusted RR 0.81, 95% CI 0.33-2.00).

“This population-based cohort study was, to our knowledge, the first to directly assess the RR of diagnosed ID in children born to mothers treated with antidepressant medication during pregnancy,” the investigators said. “We observed a higher RR of ID among offspring born to mothers treated with antidepressants during pregnancy (0.9%of children affected) compared with offspring of mothers not treated with antidepressants during pregnancy of children affected before adjustment for confounding factors.”

“However,” they added, “with incremental adjustment for maternal and paternal confounding factors, this association was gradually attenuated to a statistically nonsignificant RR estimated at 1.33 (95% CI, 0.90-1.98),” they added. “Thus, the association between offspring ID and maternal antidepressant medication may, to a large extent, be explained by confounding by the covariates included and adjusted for in the current analyses.”

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  1. Viktorin A, Uher R, Kolevzon A, et al. Association of antidepressant medication use during pregnancy with intellectual disability in offspring [published online July 12, 2017].  JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.1727. 
  2. Bromley R, Weston J, Adab N, et al. Treatment for epilepsy in pregnancy: neurodevelopmental outcomes in the child. Cochrane Database Syst Rev. 2014;10:CD010236. doi:10.1002/14651858.CD010236.pub2