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, 55 (5), 359-66

Gestational Exposure to Selective Serotonin Reuptake Inhibitors and Offspring Psychiatric Disorders: A National Register-Based Study

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Gestational Exposure to Selective Serotonin Reuptake Inhibitors and Offspring Psychiatric Disorders: A National Register-Based Study

Heli Malm et al. J Am Acad Child Adolesc Psychiatry.

Abstract

Objective: To investigate the impact of gestational exposure to selective serotonin reuptake inhibitors (SSRIs) on offspring neurodevelopment.

Method: This is a cohort study using national register data in Finland between the years 1996 and 2010. Pregnant women and their offspring were categorized into 4 groups: SSRI exposed (n = 15,729); exposed to psychiatric disorder, no antidepressants (n = 9,651); exposed to SSRIs only before pregnancy (n = 7,980); and unexposed to antidepressants and psychiatric disorders (n = 31,394). We investigated the cumulative incidence of offspring diagnoses of depression, anxiety, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD) for the 4 groups from birth to 14 years, adjusting for confounders.

Results: The cumulative incidence of depression among offspring exposed prenatally to SSRIs was 8.2% (95% CI = 3.1-13.3%) by age 14.9 years, compared with 1.9% (95% CI = 0.9-2.9%) in the psychiatric disorder, no medication group (adjusted hazard ratio [HR] = 1.78; 95% CI = 1.12-2.82; p = .02) and to 2.8% (95% CI = 1.4-4.3%) in the SSRI discontinued group (HR = 1.84; 95% CI = 1.14-2.97; p = .01). Rates of anxiety, ASD, and ADHD diagnoses were comparable to rates in offspring of mothers with a psychiatric disorder but no medication during pregnancy. Comparing SSRI exposed to unexposed individuals, the HRs were significantly elevated for each outcome.

Conclusion: Prenatal SSRI exposure was associated with increased rates of depression diagnoses in early adolescence but not with ASD or ADHD. Until confirmed, these findings must be balanced against the substantial adverse consequences of untreated maternal depression.

Keywords: ADHD; ASD; SSRI; offspring depression; pregnancy.

Conflict of interest statement

Disclosure: None of these disclosures pose conflicts of interest.

Figures

Fig 1
Fig 1
The cumulative incidence (%) of offspring diagnoses by age. Note: The cumulative incidence (%) of offspring diagnoses by age among offspring born between January 1, 1996, and December 31, 2010, and followed up to December 31, 2010 (age range from 0.0 to 14.9 years at the end of follow-up). Participants were censored from the age-defined analysis after December 31, 2010. Offspring exposed prenatally to selective serotonin reuptake inhibitors (SSRIs) are represented by magenta line, offspring exposed to maternal psychiatric disorder but no medication by cyan line, offspring of mothers discontinuing SSRI use prior to pregnancy by yellow line, and offspring unexposed to maternal psychiatric disorder and medication by black line. Panels A-D illustrate separately offspring depression (A), anxiety (B), autism spectrum disorder (ASD; C) and attention-deficit/hyperactivity disorder (ADHD; D).
Fig 2
Fig 2
Adjusted hazard ratios (HR) and 95% CIs for offspring diagnoses. Note: Adjusted HR and 95% CIs of offspring diagnoses when comparing offspring exposed prenatally to selective serotonin reuptake inhibitors (SSRIs) to offspring exposed to maternal psychiatric disorder but no medication (panel A), and to offspring born to mothers who discontinued SSRI use prior to pregnancy (panel B). ADHD = attention-deficit/hyperactivity disorder; ASD = autism spectrum disorder.

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