Balancing Antidepressants' Risks during Pregnancy

Antidepressants during pregnancy and autism may be linked but so may mood disorders

(RxWiki News) Taking antidepressants during pregnancy has always involved a balancing of possible benefits and risks. But so does skipping the medication when a mom has depression.

A recent study looked at whether taking antidepressants during pregnancy might increase the risk of autism or developmental delays in a mother's child.

The researchers found that there was an increased risk for autism with SSRIs during pregnancy, but there was a similar increased risk if the mothers had anxiety or depression.

It's not clear whether the higher odds of autism and developmental delays were due to the antidepressants or due to the mother's mental health condition or another reason.

"Discuss your medications with your OB/GYN."

This study, led by Rebecca Harrington, PhD, MPH, of the Department of Epidemiology at Johns Hopkins Bloomberg School of Public Health, looked at whether antidepressants taken during pregnancy could contribute to a risk for developmental disorders in the baby.

Specifically, the authors were studying antidepressants in the drug class known as selective serotonin reuptake inhibitors, or SSRIs.

The researchers compared 966 pairs of mothers and children, investigating the child's developmental disorder status, the mothers' use of antidepressants during pregnancy, the mothers' mental health history and the socioeconomic of the families.

Among these pairs, 492 children had an autism spectrum disorder, 154 children had delayed development, and 320 children had typical development.

Among the mothers of children with typical development, 3.4 percent had taken SSRIs during pregnancy.

Among the mothers of the other children, 5.9 percent of the mothers of children with autism, and 5.2 percent of the mothers with developmentally delayed children had taken SSRIs during pregnancy.

Boys, who are already at higher risk for autism diagnoses based on past research, had almost three times greater odds of an autism spectrum disorder if their mothers took SSRIs at any point during pregnancy than if their mothers did not.

If their mothers took SSRIs during their first trimester of pregnancy, boys had 3.2 times greater odds of an autism diagnosis.

Similarly, boys had about 3.4 times greater odds of having developmental delays if their mothers had taken SSRIs at any point during pregnancy.

If the mothers took the antidepressants during their last trimester, the boys' odds of developmental delays increased even more — to five times the odds of children whose mothers did not take SSRIs in pregnancy.

However, when the researchers looked at mothers who had an anxiety or mood disorder, they found similar rates of autism and developmental delays among the children.

Therefore, even though the study found an increase in odds for autism or developmental delays among mothers taking SSRIs in pregnancy, this increased risk could have actually been due to the mental health conditions that led the mothers to take the medications.

If mothers with anxiety or mood disorders, such as depression or bipolar disorder, have children with similar risks for developmental disorders as mothers taking SSRIs, then the risk may be more related to the underlying condition than the medication.

"Because maternal depression itself carries risks for the fetus, the benefits of prenatal SSRI use should be carefully weighed against potential harms," the researchers wrote.

According to Andre Hall, MD, an OBGYN at Birth and Women's Care, PA in Fayetteville, NC, using SSRIs during pregnancy used to be an accepted practice until the pregnancy category classification for these medications was "downgraded."

"However, if the benefits of the medication is deemed greater than the risk to the fetus, there are circumstances when SSRI use is still appropriate," Dr. Hall said. "The risks which are known and other risks that are still being debated, such as autism, should be discussed with your physician."

This study was published April 14 in the journal Pediatrics. The research was funded by the National Institute on Environmental Health Sciences, the MIND Institute and Autism Speaks. The authors reported no potential conflicts of interest.

Review Date: 
April 13, 2014