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Use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy has been linked to increased risks for miscarriage, cardiac defects, and persistent pulmonary hypertension of the newborn. In this population-based, case-control study, researchers examined fetal SSRI exposure in 298 children with medical-record diagnoses of autism spectrum disorders (ASDs) and 1507 control children. Children whose mothers received at least one antidepressant prescription in the year before delivery were considered exposed (20 case mothers and 50 control mothers; 6.7% vs. 3.3%). Mothers' psychiatric diagnoses were obtained from medical records.
Mothers of children with ASD were significantly older, more educated, and more likely to be non-Hispanic white than control mothers. Children with ASD were more likely to have low birth weight and gestational age under 37 weeks at delivery. Most prescriptions were for SSRIs. After adjustment for demographic and birth variables, the odds ratio for a child's ASD diagnosis after prenatal SSRI prescription was 2.2; with first-trimester exposure, the OR was 3.8. Maternal mental health disorders during the year before delivery were not associated with ASD in the child; after adjustment for these disorders, SSRIs' associations with ASD persisted.
Croen LA et al. Antidepressant use during pregnancy and childhood autism spectrum disorders. Arch Gen Psychiatry 2011 Jul 4; [e-pub ahead of print]. (http://dx.doi.org/10.1001/archgenpsychiatry.2011.73)
Comment
This study indicates a possible association between SSRI exposure and childhood ASD, which can be explained as either a two- to threefold increase in risk or as an increase from 1% to 2% or 3%. Although the study was carefully done, its findings need to be replicated. Prescription use was not confirmed, diagnoses were from medical records and not psychiatric interviews, and factors such as tobacco, alcohol, and drug use were not controlled for.
SSRI exposure might be one of the environmental factors implicated in autism (JW Psychiatry Aug 15 2011). And yet, the risks posed by medication must be weighed against risks for recurrent depression. If taken off antidepressants during pregnancy, two thirds of women with recurrent major depression relapse, and half of these relapses occur in the first trimester. Depressed patients who are or wish to become pregnant are likely to wonder about the association between SSRI use and ASD, and clinicians should be prepared to discuss this small two- to threefold increase in risk, along with the other risks of SSRIs and of untreated depression.