Gestational Exposure to Selective Serotonin Reuptake Inhibitors and Offspring Psychiatric Disorders: A National Register-Based Study

J Am Acad Child Adolesc Psychiatry. 2016 May;55(5):359-66. doi: 10.1016/j.jaac.2016.02.013. Epub 2016 Mar 3.

Abstract

Objective: To investigate the impact of gestational exposure to selective serotonin reuptake inhibitors (SSRIs) on offspring neurodevelopment.

Method: This is a cohort study using national register data in Finland between the years 1996 and 2010. Pregnant women and their offspring were categorized into 4 groups: SSRI exposed (n = 15,729); exposed to psychiatric disorder, no antidepressants (n = 9,651); exposed to SSRIs only before pregnancy (n = 7,980); and unexposed to antidepressants and psychiatric disorders (n = 31,394). We investigated the cumulative incidence of offspring diagnoses of depression, anxiety, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD) for the 4 groups from birth to 14 years, adjusting for confounders.

Results: The cumulative incidence of depression among offspring exposed prenatally to SSRIs was 8.2% (95% CI = 3.1-13.3%) by age 14.9 years, compared with 1.9% (95% CI = 0.9-2.9%) in the psychiatric disorder, no medication group (adjusted hazard ratio [HR] = 1.78; 95% CI = 1.12-2.82; p = .02) and to 2.8% (95% CI = 1.4-4.3%) in the SSRI discontinued group (HR = 1.84; 95% CI = 1.14-2.97; p = .01). Rates of anxiety, ASD, and ADHD diagnoses were comparable to rates in offspring of mothers with a psychiatric disorder but no medication during pregnancy. Comparing SSRI exposed to unexposed individuals, the HRs were significantly elevated for each outcome.

Conclusion: Prenatal SSRI exposure was associated with increased rates of depression diagnoses in early adolescence but not with ASD or ADHD. Until confirmed, these findings must be balanced against the substantial adverse consequences of untreated maternal depression.

Keywords: ADHD; ASD; SSRI; offspring depression; pregnancy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Anxiety Disorders / chemically induced*
  • Anxiety Disorders / drug therapy
  • Anxiety Disorders / epidemiology
  • Attention Deficit Disorder with Hyperactivity / chemically induced*
  • Attention Deficit Disorder with Hyperactivity / epidemiology
  • Autism Spectrum Disorder / chemically induced*
  • Autism Spectrum Disorder / epidemiology
  • Bipolar Disorder / drug therapy*
  • Bipolar Disorder / epidemiology
  • Depressive Disorder / chemically induced*
  • Depressive Disorder / drug therapy
  • Depressive Disorder / epidemiology
  • Female
  • Finland / epidemiology
  • Follow-Up Studies
  • Humans
  • Maternal Exposure / statistics & numerical data*
  • Pregnancy
  • Prenatal Exposure Delayed Effects / chemically induced*
  • Prenatal Exposure Delayed Effects / epidemiology
  • Registries
  • Selective Serotonin Reuptake Inhibitors / adverse effects*
  • Young Adult

Substances

  • Serotonin Uptake Inhibitors