Antidepressant use during pregnancy increases risk of psychiatric disorders in children

Children of mothers who used antidepressants before and/or during pregnancy are at an increased risk of being diagnosed with a psychiatric disorder, according to a study published in the The
BMJ
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However, the authors warn that the association could be attributable to the severity of the mother’s underlying condition in combination with the child’s exposure to antidepressants in the womb because mothers with severe symptoms are more likely to continue antidepressant treatment during pregnancy.

The population-based cohort study followed 905,383 babies born during 1998–2012 in Denmark from their birth through to July 2014, death, emigration, or date of psychiatric diagnosis — whichever came first.

The children were categorised into four groups according to maternal antidepressant use within two years before and during pregnancy: unexposed, antidepressant discontinuation (used before pregnancy but not during), antidepressant continuation (used both before and during pregnancy), and new users (used only during pregnancy).

Overall, at follow-up, 32,400 (3.6%) of the children had been diagnosed with psychiatric disorders. The adjusted 15-year cumulative incidence of psychiatric disorders was 8% in the unexposed group, 11.5% in the antidepressant discontinuation group, 13.6% in the continuation group and 14.5% in the new user group. The antidepressant continuation group was found to have an increased risk of psychiatric disorders compared with the discontinuation group (hazard ratio 1.27, 1.17 to 1.38).

“Considering the health of the child, clinicians and patients should always consider the possibility of tapering off antidepressants if a woman is pregnant or planning a pregnancy,” said Xiaoqin Liu, lead author of the study, which was supported by iPSYCH, the Lundbeck Foundation Initiative for Integrative Psychiatric Research and the National Institute of Mental Health.

However, Liu added that tapering off is not recommended if previous attempts at discontinuation led to relapse, or if the woman has a history of severe and recurrent depression.

“It is important to acknowledge that a group of women will need this medication to keep them stable, as untreated depression can have a series of negative short- and long-term outcomes for both the woman as well as her child and family,” he said.

David Taylor, director of pharmacy and pathology at South London and Maudsley NHS Foundation Trust said the findings may simply reflect the fact that use of antidepressants during pregnancy is a marker for depression during pregnancy, which itself might explain the higher risk of disorder in the offspring.

“In addition, the risk seemed to be increased for all antidepressants — a diverse group of drugs with radically different chemistry and somewhat different pharmacological actions,” he said.

“It seems unlikely that all antidepressants would give the same outcome if they were the cause of mental health problems in offspring.”

Antidepressants have been increasingly used during pregnancy in the past few decades, and selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed.

According to the report, several studies have linked SSRI use during pregnancy to autism spectrum disorder in offspring, although results have been conflicting. The association may be explained by selective serotonin reuptake inhibitors crossing the placental barrier and affecting the development of the foetal brain.

“Most previous studies on antidepressant use in pregnancy have focused solely on autism risk in the exposed children, said Liu. “Our results suggest that focusing only on a single psychiatric disorder among offspring in studies of in utero antidepressant exposure may be too restrictive.”