Does taking antidepressants during pregnancy impact children’s brains?

Research published in JAMA Internal Medicine shows that taking antidepressants while pregnant does not increase the risk of children developing neurodevelopmental disorders.
 
However, the Harvard Medical School crude data reveals an association between antidepressants in pregnancy and neurodevelopmental issues, which could be an important marker for the need for early screening and intervention in exposed children.
 
The study’s lead author, Dr Elizabeth Suarez, told newsGP the research adds ‘clarity’ to the discussion around antidepressant use during pregnancy.
 
‘Antidepressants are one of the most commonly used medications in pregnancy and during reproductive years, therefore the safety of antidepressants during pregnancy is of great interest to providers and patients,’ she said.
 
‘Many patients discontinue treatment because they are concerned about potential risks. We believe these results are reassuring and will help patients and providers balance the risks and benefits of treatment during pregnancy.
 
‘We found that antidepressant use is unlikely to increase the risk of neurodevelopmental disorders in children, and any observed association is likely due to factors associated with antidepressant use, such as the indication [depression, anxiety, etcetera], health and lifestyle factors associated with having depression or anxiety, environmental and genetic risk factors.’
 
Previous research has been conflicting about whether antidepressants increase the risk of neurodevelopmental disorders (NDD), autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD).
 
Consultant obstetrician/gynaecologist, Associate Professor Alex Polyakov, told newsGP this new research adds to existing knowledge.
 
‘The study is reassuring but it’s not new, this has been known for a while. Multiple studies have looked at this issue,’ he said.
 
‘The NDD outcomes have been studied previously with similar results. NDD outcomes of babies are the same whether mums take antidepressants or not.’
 
The authors note that ASD is the most widely studied NDD in relation to antidepressant exposure during pregnancy.
 
‘Studies using population-based registries in Nordic countries and Canadian provinces [report] estimates of a 20–80% increase in ASD risk with antidepressant exposure,’ they wrote.
 
‘But [those] analyses suggest that uncontrolled confounding by indication and environment may be a likely explanation in some but not all of these studies.’
 
The Harvard study analysed a database of more than two million pregnancies and classified antidepressant exposure as at least one dispensing from week 19 of gestation, which is the approximate period of synaptogenesis in the fetus, to delivery.
 
More than 145,700 pregnancies were exposed to antidepressants, which included serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors and tricyclic antidepressants. Exposure to individual antidepressant drugs was assessed for the five most commonly used drugs (sertraline, fluoxetine, bupropion, citalopram, and escitalopram).
 
Outcomes studied included ASD, ADHD, specific learning disorders, developmental speech/language disorders, developmental coordination disorders, intellectual disabilities and behavioural disorders.
 
Associate Professor Polyakov believes the study was very good, but not without limitations.
 
‘They may rely on data that isn’t 100% accurate, because they look at dispensing of antidepressants and some people may buy it but not take it,’ he said.
 
‘Others may take medication they were prescribed previously. So, the granular details can’t always be worked out fully.’
 
Women using antidepressants during pregnancy had a higher risk of having a child with an NDD than individuals not using antidepressants, but after adjustment for an extensive list of potential confounders, no difference was found.
 
Further, when they compared results with antidepressant discontinuation and pregnancies with unexposed siblings, there was also no difference for all outcomes. The authors state this points to an increased risk of NDDs owing to factors associated with antidepressant use during pregnancy, but not the medication itself.
 
Dr Rodney Petersen, a GP and obstetrician/gynaecologist in Canberra, told newsGP the study is reassuring.
 
‘[It] will reassure most women that, should they require an antidepressant during their pregnancy, then [they] do not increase the risk of ADHD and neurodevelopmental issues in their child,’ he said.
 
‘As with all conditions in pregnancy, caution should be exercised with all types of treatments and medications.
 
‘However, if treatment for a condition is necessary then a risk/benefit discussion needs to be had between the woman and her primary provider of obstetric care.’
 
It is estimated that 1% of Australians have ASD and 0.5% have ADHD. In Australia, estimates of antidepressant use in pregnancy vary between 1–2%, while in the USA it is closer to 8%.
 
The authors note that children exposed to antidepressants in pregnancy could be marked for early screening and intervention, with the goal of improving outcomes for NDDs.
 
Associate Professor Polyakov said that while the potential of NDDs in children should be kept in mind, it’s important to remember that depression can have serious effects on a pregnancy.
 
‘Depression is a serious condition, especially in pregnancy and it can get worse during or especially after giving birth due to hormonal fluctuation,’ he said.
 
‘My personal approach is to not stop antidepressants. Ideally, we would address their use pre-conceptually if possible and advise extra monitoring by a psychiatrist if necessary.
 
‘Untreated depression can affect self-care during pregnancy, [and] can affect family dynamics and care for the newborn. So it’s extremely important to keep it under control.’
 
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ADHD antidepressants ASD children neurodevelopment pregnancy