The children of mothers who had depression-related psychiatric disorders and purchased selective serotonin reuptake inhibitors (SSRIs) at least twice when they were pregnant had an increased risk for speech/language disorders but further studies are needed before conclusions can be drawn about possible clinical implications, according to an article published online by JAMA Psychiatry.
The use of SSRIs during pregnancy is increasing. SSRIs cross the placenta and enter the fetal circulation.
Alan S. Brown, M.D., M.P.H., of the Columbia University College of Physicians and Surgeons and the Mailman School of Public Health, New York, and coauthors examined exposure to SSRIs during pregnancy and the risk of speech/ language, scholastic and motor disorders in children up to early adolescence. The authors used register data in Finland from 1996 to 2010 and the final study group included 56,340 infants (about 51 percent male).
The offspring were divided into three groups:
- 15,596 were in the SSRI-exposed group because their mothers were diagnosed as having depression-related psychiatric disorders with a history of purchasing SSRIs during pregnancy.
- 9,537 were in the unmedicated group because their mothers were diagnosed as having depression-related psychiatric disorders or other psychiatric disorders associated with SSRI use but had no history of purchasing SSRIs during pregnancy.
- 31,207 were in the unexposed group because they were unexposed prenatally to an SSRI or had mothers without a psychiatric diagnosis.
The average ages of children at diagnosis were 4.4 years old for speech/language disorders, 3.5 years for scholastic disorders and 7.7 years for motor disorders.
The children of mothers who purchased SSRIs at least twice during pregnancy had a 37 percent increased risk of speech/language disorders compared with offspring in the unmedicated group and a 63 percent increased risk compared with children in the unexposed group, according to the results.
In the whole study sample, regardless of the number of SSRI purchases, the risk of speech/language disorders was increased among the children of mothers who used SSRIs during pregnancy as well as the children of mothers diagnosed as having depression or other psychiatric disorders who did not take SSRIs compared with children in the unexposed group who had mothers with no psychiatric diagnoses or SSRI use, the authors report.
For scholastic and motor disorders there were no differences in risk between children in the SSRI-exposed group and the unmedicated group.
Limitations include the study is observational and therefore causality cannot be inferred. The authors also cannot confirm from population registries that the purchased SSRIs were taken. However, the association between maternal SSRI purchase and clinical speech and language disorders was present only among mothers with more than one SSRI purchase during pregnancy, according to the study.
"We found a significant increase in the risk of speech/language disorders among offspring of mothers who purchased SSRIs at least twice during pregnancy compared with mothers diagnosed as having depression or other psychiatric disorders not treated with antidepressants. Further studies are necessary to replicate these findings and to address the possibility of confounding by additional covariates before conclusions regarding the clinical implications of the results can be drawn," the study concludes.
(JAMA Psychiatry. Published online October 12, 2016. doi:10.1001/ jamapsychiatry.2016.2594. Available pre-embargo to the media at http://media.
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