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Is Prenatal SSRI Exposure Linked to Autism Spectrum Disorders in Children?

Summary and Comment |
August 29, 2011

Is Prenatal SSRI Exposure Linked to Autism Spectrum Disorders in Children?

  1. Deborah Cowley, MD

A single study suggests an association.

  1. Deborah Cowley, MD

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.

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.

Citation(s):

Reader Comments (4)

Deborah Cowley, MD, and Barbara Geller, MD

Yes, this is correct. It is biologically plausible. A recent study (Nature 2011 Apr 21; 472:347) found that serotonin is supplied to the fetus from the placenta. So, it is possible that SSRIs act on serotonin pathways in the placenta, which are involved in fetal neuronal development.

Whether this has clinically significant effects at commonly used SSRI doses has yet to be determined.

Competing interests: Dr. Cowley is the author of the summary.

Arleen G Haynes-Laing MD MPH FAAP

Inspite of the limitations, this was a well designed study that appears to link the effects of SSRIs on fetal neuronal development. Previous neuroscience research, illustrate adverse effects on fetal neuronal development with alterations in serotonin levels. It is biologically plausible that these drugs may alter fetal neuronal development.

Competing interests: None declared

Deborah Cowley, MD

It is indeed very important for us as clinicians to understand these findings and to put them into perspective for our patients, many of whom have read about this study in the national news media and may be alarmed.

This study was well designed and took into account mental health disorders in mothers. Nevertheless, as mentioned in the JW Psychiatry summary, it has several limitations, including not controlling for tobacco, alcohol, or illicit drug use. Also, with a base rate of autism spectrum disorders (ASD) of 1%, we will need several studies with large sample sizes to determine whether the association with SSRI exposure is real. Even assuming that the findings of this study are correct, the rate of ASD increases from 1% to 2%-3%, so that 97%-98% of babies would be unaffected.

Competing interests: Summary author

william horn

The vast majority of people with ASD are born to mothers who are NOT taking an SSRI. Similarly, the vast majority of pregnant women taking SSRIs have healthy babies.

The possibilities for confounders here is astronomical -what type of person takes an SSRI? someone with a certain genetic makeup? Someone who is poor? Has more environmental hazards? etc.

Strikes me as rather alarmist and irresponsible to publish this type of study design.

Competing interests: None declared

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