Use of antidepressants before and during pregnancy does not cause autism, or attention-deficit/hyperactivity disorder (ADHD) new research shows.
Three studies demonstrate that antidepressant use in pregnant women is likely not responsible for autistic spectrum disorders (ASDs) in children and that the association found in previous studies was likely due to confounding factors.
A team of researchers headed by Simone N. Vigod, MD, of Women’s College Hospital, Toronto, Canada, evaluated the association between gestational serotonergic antidepressant exposure and childhood ASD in 35,906 births.
In the 2837 pregnancies (7.9%) involving exposure to antidepressants, 2% of children were diagnosed with ASD, a percantage that was higher than in the children who had not been exposed. However, once the researchers adjusted for confounding factors, the difference was no longer significant. Nor was it significant when exposed children were compared with unexposed siblings.
“We will never be able to say for certain that a medication has zero risks,” Dr Vigod told Medscape Medical News. “But these data, together with the findings of the other studies published this week, are reassuring and suggest that antidepressants during pregnancy are reasonably low risk.”
In another study, Brian M D’Onofrio, PhD, of Indiana University, Bloomington, and colleagues focused on the confounding factors between first-trimester antidepressant exposure and birth and neurodevelopmental problems.
The researchers analyzed a database of more than 1.5 million Swedish offspring born between 1992 and 2012 for whom follow-up was available through 2013. Of these, 1.4% (n = 22,544) were born to mothers who self-reported antidepressant use during their first trimester.
The researchers used sophisticated statistical methods to account for a variety of confounding factors. After controlling for these factors, they found that first-trimester antidepressant exposure, as compared to nonexposure, was associated with a “small increased risk of preterm birth,” but not with increased risk for having small size for gestational age, ASD, or ADHD.
“Our study suggests that it is not the medication use during pregnancy per se that explains why children of mothers who use these medications have more problems than children whose mothers do not,” Dr D’Onofrio told.
The studies were published in the April 18 issue of JAMA.
The third article is a meta-analysis conducted by Florence Gressier, MD, PhD, of the Bicêtre University Hospital, Le Kremlin-Bicêtre, France, and colleagues. The researchers analyzed 10 studies with “inconsistent results” regarding the association of ASD with fetal exposure to antidepressants for each trimester and during the preconception period.
Although the researchers found a significant association between increased ASD risk and maternal use of antidepressants during pregnancy, the association was more consistent during the preconception period than during each trimester. Moreover, the association was weaker when the researchers controlled for past maternal mental illness.
“Previously reported differences between exposed and unexposed children may come from statistical fluctuations, different criteria of evaluation, and different modelings,” Dr Gressier told.
This study was published in the April 17 issue of JAMA Pediatrics.