Women with depression and other mood disorders are generally advised to continue taking antidepressant medications during pregnancy. The drugs are widely considered safe, but the effect of these medications on the unborn fetus has remained a topic of some concern. Now, researchers have found that maternal psychiatric conditions - but not the use of serotonin-selective reuptake inhibitors (SSRI) - increased the risk for autism spectrum disorder (ASD) and developmental delay (DD) in offspring.
The study appears in Biological Psychiatry, published by Elsevier.
Previous studies had found links between SSRI use and ASD in offspring, and ASD is associated with disrupted serotonergic pathways. But the question of whether medication or underlying conditions are responsible remained muddy.
Jennifer Ames, PhD, from Kaiser Permanente and lead author of the new study, said,
Our latest findings are good news for women managing psychiatric conditions such as depression and anxiety while pregnant and are consistent with a growing body of research that's trying to better disentangle the separate relationships of the mother's SSRI treatment and psychiatric indications during pregnancy with child neurodevelopment."
Dr. Ames and colleagues used data from the Study to Explore Early Development (SEED), which collected information about the development of thousands of children born across the US between 2003 and 2011. The current analysis of SEED data included three groups of children: those with ASD (1,367 children); with DD (1,750 children); or healthy population controls (1,671 children).
Mothers were determined to have psychiatric disorders and to have taken SSRIs during pregnancy based on self-report and on medical records. About a third of mothers in the study had a psychiatric condition before or during pregnancy, and about a quarter of those took SSRIs or other antidepressants.
The findings indicated that the risk of ASD or DD was roughly doubled for children of mothers with a psychiatric disorder compared to those without. But importantly, the use of SSRIs was not associated with increased risk.
John Krystal, MD, Editor of Biological Psychiatry, said of the work, "Parents have been concerned about the risks posed to infants when mothers take antidepressant medications. It is a big relief to see that maternal antidepressant consumption does not increase the risk for autism spectrum disorder or other neurodevelopmental disorders. However, this study does confirm that maternal psychiatric disorders are associated with increased risk for autism spectrum disorder in offspring."
"Our study has some unique strengths such as including a large and demographically diverse group of mothers and children in the United States, an analysis of specific subgroups of children with autism spectrum disorder and other developmental disorders, and an examination of multiple types of psychiatric conditions in the mothers," added Dr. Ames.
The findings should provide some peace of mind for the estimated 6% of pregnant women in the US taking SSRIs.
Ames, J. L., et al. (2021) Maternal psychiatric conditions, treatment with SSRIs, and neurodevelopmental disorders. Biological Psychiatry. doi.org/10.1016/j.biopsych.2021.04.002.