Do Antidepressants During Pregnancy Increase Autism Risk?
Previous studies have been conflicting as to whether exposure to serotonergic antidepressants during pregnancy may increase autism risk in offspring. There is the possibility that the underlying disorder, such as depression, is responsible for the increased autism risk in some papers, and not the medication. This study by Brown et al. (JAMA, 2017) explores the association between serotonergic antidepressant exposure during pregnancy and child autism spectrum disorder, with a major focus on addressing potential confounding factors.
Retrospective Cohort Study
35,906 singleton births with a mean gestational age of 38.7 weeks were surveyed. Incidence of autism spectrum disorder was 4.51/1000 person-years among children exposed to antidepressants (selective serotonin or serotonin-norepinephrine reuptake inhibitors) vs. 2.03/1000 person-years among children who were not exposed (between-group difference, 2.48 [95% CI, 2.33-2.62] per 1000 person-years; hazard ratio, 2.16 [95% CI, 1.64-2.86]; adjusted HR, 1.59 [95% CI, 1.17-2.17]. Using high-dimensional propensity score technique to account for covariates that could predict treatment (for example, does depression make you more likely to take this drug) the investigators found no association between serotonergic antidepressants and autism spectrum disorder (Hazard Ratio 1.61 [95% CI, 0.997-2.59]). The association was also not significant when exposed children were compared to unexposed siblings (Hazard Ratio, 1.60 [95% CI, 0.69-3.74]). Another paper appearing in JAMA in the same issue by Sujan et al. also found no association between first trimester antidepressant use and autism spectrum disorder and attention-deficit/hyperactivity (ADHD) disorder. The editorial by Oberlander and Zwaigenbaum concludes that addressing maternal mental health must be prioritized as depression is associated with developmental disturbances. Rather than focusing on antidepressants in isolation, research is needed to determine which patients and offspring could benefit from appropriate antidepressant treatment.
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