SSRI Exposure During Pregnancy and Risk for Autism Spectrum Disorders

December 18, 2013

SSRI Exposure During Pregnancy and Risk for Autism Spectrum Disorders

  1. Deborah Cowley, MD

A large cohort study fails to confirm a link suggested by a smaller study.

  1. Deborah Cowley, MD

Use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy has been associated with a twofold increased risk for autism spectrum disorders (ASDs) in offspring, but the study involved only 298 children with ASDs (NEJM JW Psychiatry Aug 29 2011). These researchers investigated the potential association in a larger cohort study relying on Danish nationwide registries during a 10-year period through 2005, which covered 626,875 live singleton births of known gestational age and without genetic anomalies associated with an increased risk for ASDs.

There were 6068 mothers (about 1%) using SSRIs during pregnancy (starting from 2 years before pregnancy until delivery) and 3892 children diagnosed with ASDs. Maternal psychiatric diagnoses and use of drugs other than SSRIs (antipsychotics, mood stabilizers, category D drugs) during pregnancy were associated with higher rates of ASDs in unadjusted analyses. SSRI use was associated with less education, lower socioeconomic status, and greater likelihood of psychiatric diagnoses, other medication use, and smoking during pregnancy. In analyses controlling for these factors, ASD risk did not increase with SSRI exposure during pregnancy.


This study has the strength of using data from a large, nationwide cohort and of controlling for potentially confounding factors. The results suggest that higher rates of ASDs are associated, not with SSRIs during pregnancy, but with other factors, such as maternal psychiatric diagnoses and use of medications other than SSRIs during pregnancy. However, the authors note that their results rule out only an increase in risk greater than 61% so that a smaller increase in risk remains possible.

Editor Disclosures at Time of Publication

  • Disclosures for Deborah Cowley, MD at time of publication Grant / research support Health Resources and Services Administration Leadership positions in professional societies American Association of Directors of Psychiatric Residency Training (Co-Chair, Pre-Meeting Task Force)


Reader Comments (2)

Deborah Cowley, MD Physician, Psychiatry, Professor of Psychiatry and Vice Chair for Education and Director of the Residency Training Program in the Department of Psychiatry and Behavioral Sciences at the University of Washington Medical Center
Competing Interests: Summary author

It would be very useful to know SSRI dosages, but the article did not provide this information. The timing of exposure during pregnancy was defined as any filled prescription between 4 weeks before the beginning of pregnancy and delivery, although the authors did examine first-trimester exposure separately. There was also no increase in ASD risk with first trimester exposure.

Hedi Chable Fellow-In-Training, BC Children Hospital

I will like to know more about the dosage and the time that the mothers were taking SSRI.
Thank you so much

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