We have long been interested in understanding the effects of prenatal exposure to antidepressants on the development of the fetal brain.  The earliest studies addressing this question were small but yielded detailed (and reassuring) information regarding the cognitive development of children exposed to antidepressants in utero.  The findings of these studies supported the hypothesis that prenatal exposure to SSRI antidepressants has no long-term negative effects on the child’s cognitive development.

More recent studies on the effects of prenatal exposure to antidepressants have relied upon larger medical databases.  While these studies are limited in that they may not be able to accurately take into account all maternal exposures and may not yield as detailed information on outcomes, they have given us the opportunity to examine large numbers of children exposed to antidepressants during pregnancy.  

A recent study from Viktorin and colleagues has examined the association between maternal antidepressant use during pregnancy and intellectual functioning in the offspring and has investigated the impact of parental psychiatric illness on this association.  For this analysis, mothers and offspring (born in 2006 and 2007) were identified using the Swedish Medical Birth Register, which covers 99% of all births nationwide.

The study included 179?007 children.  The mean age at the end of follow-up was 7.9 years; 51.5% of the children were male and 48.5% female.  The cohort included 3982 children (2.2%) born to mothers with at least 2 dispensations of antidepressant medication during pregnancy.

Intellectual disability is typically diagnosed in childhood and is defined by an IQ below 70 along with adaptive deficits which impair everyday functioning.  In the current study, intellectual disability (ID) was defined as having at least one inpatient or outpatient specialist care visit with an ICD-10 code of F70 to F79.  ID was diagnosed in 37 children (0.9%) exposed to antidepressants and in 819 children (0.5%) unexposed to antidepressants.

The unadjusted relative risk (RR) of ID in the children exposed to antidepressants during pregnancy was estimated to be 1.97 (95% CI, 1.42- 2.74).  However, after adjusting for potential confounders (including maternal and paternal age and history of psychiatric illness in the mother), the association was no longer significant, and the RR was estimated at 1.33 (95% CI, 0.90-1.98).

In conclusion, the current study did not find any evidence of an association between intellectual disability in children and maternal antidepressant use during pregnancy. This study suggests that the association seen in unadjusted analyses may be attributable to factors other than antidepressant exposure, such as parental age and maternal psychiatric illness.

Rut Nonacs, MD PhD

Viktorin A, Uher R, Kolevzon A, Reichenberg A, Levine SZ, Sandin S.  Association of Antidepressant Medication Use During Pregnancy With Intellectual Disability in Offspring.  JAMA Psychiatry. 2017 Jul 12.



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