Philadelphia, June 24, 2021 - Women with depression and other mood disorders are generally advised to continue taking antidepressant medications during pregnancy. The drugs are widely considered safe, but the effect of these medications on the unborn fetus has remained a topic of some concern. Now, researchers have found that maternal psychiatric conditions - but not the use of serotonin-selective reuptake inhibitors (SSRI) - increased the risk for autism spectrum disorder (ASD) and developmental delay (DD) in offspring.
The study appears in Biological Psychiatry, published by Elsevier.
Previous studies had found links between SSRI use and ASD in offspring, and ASD is associated with disrupted serotonergic pathways. But the question of whether medication or underlying conditions are responsible remained muddy.
Jennifer Ames, PhD, from Kaiser Permanente and lead author of the new study, said, "Our latest findings are good news for women managing psychiatric conditions such as depression and anxiety while pregnant and are consistent with a growing body of research that's trying to better disentangle the separate relationships of the mother's SSRI treatment and psychiatric indications during pregnancy with child neurodevelopment."
Dr. Ames and colleagues used data from the Study to Explore Early Development (SEED), which collected information about the development of thousands of children born across the US between 2003 and 2011. The current analysis of SEED data included three groups of children: those with ASD (1,367 children); with DD (1,750 children); or healthy population controls (1,671 children). Mothers were determined to have psychiatric disorders and to have taken SSRIs during pregnancy based on self-report and on medical records. About a third of mothers in the study had a psychiatric condition before or during pregnancy, and about a quarter of those took SSRIs or other antidepressants.
The findings indicated that the risk of ASD or DD was roughly doubled for children of mothers with a psychiatric disorder compared to those without. But importantly, the use of SSRIs was not associated with increased risk.
John Krystal, MD, Editor of Biological Psychiatry, said of the work, "Parents have been concerned about the risks posed to infants when mothers take antidepressant medications. It is a big relief to see that maternal antidepressant consumption does not increase the risk for autism spectrum disorder or other neurodevelopmental disorders. However, this study does confirm that maternal psychiatric disorders are associated with increased risk for autism spectrum disorder in offspring."
"Our study has some unique strengths such as including a large and demographically diverse group of mothers and children in the United States, an analysis of specific subgroups of children with autism spectrum disorder and other developmental disorders, and an examination of multiple types of psychiatric conditions in the mothers," added Dr. Ames.
The findings should provide some peace of mind for the estimated 6% of pregnant women in the US taking SSRIs.
Notes for editors
The article is "Maternal psychiatric conditions, treatment with SSRIs, and neurodevelopmental disorders," by Jennifer Ames, Christine Ladd-Acosta, Daniele Fallin, Yinge Qian, Laura Schieve, Carolyn DiGuiseppi, Li-Ching Lee, Eric Kasten, Guoli Zhou, Jennifer Pinto-Martin, Ellen Howerton, Christopher Eaton, Lisa Croen (https://doi.org/10.1016/j.biopsych.2021.04.002). It appears as an Article in Press in Biological Psychiatry, published by Elsevier.
Copies of this paper are available to credentialed journalists upon request; please contact Rhiannon Bugno at Biol.Psych@sobp.org or +1 254 522 9700. Journalists wishing to interview the authors may contact Jennifer Ames at Jennifer.L.firstname.lastname@example.org or +1 510 301 3688 or Jan Greene at Janice.X.Greene@kp.org or +1 510 504 2663.
The authors' affiliations and disclosures of financial and conflicts of interests are available in the article.
John H. Krystal, MD, is Chairman of the Department of Psychiatry at the Yale University School of Medicine, Chief of Psychiatry at Yale-New Haven Hospital, and a research psychiatrist at the VA Connecticut Healthcare System. His disclosures of financial and conflicts of interests are available here.
About Biological Psychiatry
Biological Psychiatry is the official journal of the Society of Biological Psychiatry, whose purpose is to promote excellence in scientific research and education in fields that investigate the nature, causes, mechanisms and treatments of disorders of thought, emotion, or behavior. In accord with this mission, this peer-reviewed, rapid-publication, international journal publishes both basic and clinical contributions from all disciplines and research areas relevant to the pathophysiology and treatment of major psychiatric disorders.
The journal publishes novel results of original research which represent an important new lead or significant impact on the field, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Reviews and commentaries that focus on topics of current research and interest are also encouraged.
Biological Psychiatry is one of the most selective and highly cited journals in the field of psychiatric neuroscience. It is ranked 7th out of 155 Psychiatry titles and 12th out of 271 Neurosciences titles in the Journal Citations Reports® published by Clarivate Analytics. The 2019 Impact Factor score for Biological Psychiatry is 12.095. http://www.sobp.org/journal
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