When we meet with women to discuss the reproductive safety of antidepressant medications, one of the most challenging and anxiety-provoking aspects of the consultation is the discussion we have regarding the long-term effects of prenatal antidepressant exposure on the child. Does antidepressant exposure during the earliest stages of brain development have lasting effects?
Because studies assessing the effects of prenatal exposure to medication (or other environmental exposures) take decades to complete and because there are so many factors after birth that affect the child’s development, our information regarding this important question is limited.
Several (but not all) studies have documented an association between prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) and slight delays in motor development. One of the difficulties in interpreting these findings, however, is that they did not control for depression or anxiety symptoms in the mother. This is important because we have data to indicate that untreated depression and anxiety may also have a negative effect on both cognitive and motor development.
A recent study assesses motor development in children exposed to SSRI antidepressants, taking into consideration the effects of maternal symptoms of anxiety and depression before, during and after pregnancy. This analysis was part of the Norwegian Mother and Child Cohort study (MoBa), a large population-based prospective pregnancy cohort study. In this study, children were assessed at 3 years of age, and motor development was assessed by maternal reports of fine and gross motor development using items from the Ages and Stages Questionnaire (ASQ). Maternal ASQ scores were compared to data from a MoBa sub-study where clinicians assessed motor development using the Gross and Fine Motor Mullen scales of early learning.
51,404 children were included in the analysis. 381 women (0.7%) reported the use of SSRIs during pregnancy. Of these, 159 women reported prolonged use of an SSRI (defined as exposure at at least two timepoints during pregnancy). Children with prolonged SSRI exposure were more likely to exhibit delays in fine motor development (odds ratio 1.42, 95% CI 1.07-1.87) as compared to children with no SSRI exposure, after adjusting for symptoms of anxiety and depression before and during pregnancy. The severity of maternal depression seemed to explain the association only partially. Depression after pregnancy appeared to have no impact on the estimated effect of SSRIs.
While this study indicates that prolonged prenatal exposure to SSRIs was associated with delayed motor development at 3 years of age, this was a weak association. Furthermore, only a few children had clinically significant impairment in motor development, and the association between SSRI exposure and clinical impairment was only borderline statistically significantly different from zero. This finding will be reassuring to many women making decisions regarding the use of antidepressants during pregnancy.
Ruta Nonacs, MD PhD
Handal M, Skurtveit S, Furu K, Hernandez-Diaz S, Skovlund E, Nystad W, Selmer R. Motor development in children prenatally exposed to selective serotonin reuptake inhibitors: a large population-based pregnancy cohort study. BJOG. 2015 Sep 15.