Externalizing and attentional behaviors in children of depressed mothers treated with a selective serotonin reuptake inhibitor antidepressant during pregnancy

Arch Pediatr Adolesc Med. 2007 Jan;161(1):22-9. doi: 10.1001/archpedi.161.1.22.


Objective: To evaluate attentional and activity behaviors in 4-year-olds following prenatal selective serotonin reuptake inhibitor (SSRI) exposure.

Design: Prospective cohort design.

Setting: Tertiary care center.

Participants: Twenty-two 4-year-olds with prolonged prenatal SSRI medication exposure and 14 children without prenatal exposure.

Main exposure: Prenatal SSRI exposure.

Main outcome measures: Group differences in externalizing behaviors (according to the Child Behavior Checklist) and direct observations of child attention, activity, and impulsiveness in a laboratory setting using the procedure by Crowell and colleagues were compared, including measures of the duration of prenatal SSRI exposure, umbilical cord drug levels, a history of poor neonatal adaptation, and maternal mood.

Results: Externalizing behaviors did not differ between groups. Maternal depression and anxiety at the 4-year follow-up were associated with increased reports of externalizing behaviors. Increased externalizing behaviors were associated with increased umbilical cord drug levels (F(1,34) = 6.3; P = .02), but when controlling for maternal depressed mood at the 4-year follow-up, such levels only accounted for 11.2% of the behavioral outcomes (P>.05). On direct observation, the persistence score for child behavior was significantly lower in the exposed group. Increased aggressiveness scores were associated with a history of poor neonatal adaptation, even when parental report of stress was added to the model (F(1,34) = 4.0; P = .03); however, neither parental report of stress nor poor neonatal adaptation were significant (both P = .09), suggesting that both are important, if not unique, predictors of child behavior.

Conclusions: These findings suggest that the best predictors of externalizing behaviors at age 4 years are current maternal mood and parental stress, regardless of prenatal depressed mood and SSRI treatment during pregnancy. It remains uncertain whether poor neonatal adaptation can be excluded as a possible predictor of externalizing behaviors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attention / drug effects*
  • Child Behavior / drug effects*
  • Child, Preschool
  • Depression / drug therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Maternal Exposure / adverse effects*
  • Pregnancy
  • Pregnancy Complications / drug therapy*
  • Pregnancy Complications / psychology
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Serotonin Uptake Inhibitors / therapeutic use*


  • Serotonin Uptake Inhibitors