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.  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 during pregnancy and after birth which may affect the child’s development, our information regarding this important question is limited and sometimes difficult to interpret.

In 2011, Caspar and colleagues reported an association between prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) and slight delays in motor development.  However, this has not been a consistent finding.  For example, the large Swedish study from Brown and colleagues published a few weeks ago did not show any association between prenatal SSRI exposure and risk for motor disorders in children up to 14 years of age.  One of the difficulties, however, in interpreting these findings is that it is difficult to adequately control for potential confounding factors, most notably 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.  

In a recent study, Norwegian researchers took a new look at the effects of prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) on motor development in children at three years of age.  They conducted a population-based prospective pregnancy cohort study and attempted to take into consideration the effect of untreated maternal anxiety and depressive symptoms before, during, and after pregnancy.

The analysis included a total of 51,404 singleton pregnancies from the Norwegian Mother and Child Cohort study (MoBa, 1999-2008).  Self-reported use of SSRIs was collected for the 6 months before pregnancy and prospectively during pregnancy.   Motor development was assessed when the children were three years of age, using maternal reports of fine and gross motor development items on the Ages and Stages Questionnaire (ASQ). To assess the accuracy of the mothers’ reports, the maternal ASQ scores were compared with data from a MoBa sub-study where clinicians assessed motor development with the Gross and Fine Motor Mullen Scales of Early Learning.

In this group, 381 women (0.7%) reported use of SSRIs during pregnancy, but only 159 reported SSRI use on at least two questionnaires (which was defined as “prolonged use”).

Prolonged SSRI exposure was associated with a delay in fine motor development.  The severity of maternal depression seemed to explain the association only partially.  After adjusting for symptoms of anxiety and depression in the mother before and during pregnancy, the researchers observed a small but statistically significant delay in fine motor development in SSRI-exposed children, odds ratio 1.42 (95% CI 1.07-1.87) compared to children with no SSRI exposure.

This study, like many others, indicates that while antidepressants may carry some risks when used during pregnancy, we must also take into consideration the impact of untreated depression and anxiety in the mother on risk for adverse outcomes.  The authors concluded that prenatal exposure to SSRIs was weakly associated with delayed motor development in children at 3 years of age, “but not to the extent that the delay was of clinical importance.”

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. 2016 Nov; 123(12):1908-1917.