Is SSRI/SNRI Use in Pregnancy Associated with a Risk of Childhood Seizures and Epilepsy?
BACKGROUND AND PURPOSE:
Wiggs et al. (Neurology, 2022) assessed whether children born to women who use serotonergic antidepressants during pregnancy have higher risk for neonatal seizures and epilepsy
National register-based cohort study
Swedish register-based data
Mothers and their children born between 1996 and 2013
Self-reported use of selective-serotonin reuptake inhibitor (SSRI) and selective serotonin-norepinephrine reuptake inhibitors (SNRI) in pregnancy
Adjustments to account for confounding included
Maternal indication for SSRI/SNRI use (i.e., depression and anxiety)
History of parental epilepsy
Parental background factors (e.g., age, comorbidities, education, and family socioeconomic indices)
Pregnancy-specific characteristics (e.g., maternal use of other psychotropic medications and tobacco smoking in early pregnancy)
Diagnosis of neonatal seizures and/or epilepsy in children
Data on 1.2 million children derived from the registry
Reported use of SSRI/SNRI in pregnancy was associated with elevated risk of neonatal seizures and epilepsy
Risk ratio (RR) 1.41 (95% CI, 1.03 to 1.94)
Hazard ratio (HR) 1.21 (95% CI, 1.03 to 1.43)
Associations were attenuated by adjustment for maternal indications for SSRI/SNRI use
RR 1.30 (95% CI, 0.94 to 1.79)
HR, 1.13 (95% CI, 0.95 to 1.33)
Associations were not attenuated by additional adjustment for parental history of epilepsy
Full adjustment for all measured parental and pregnancy-specific factors resulted in substantial attenuation
RR 1.10 (95% CI, 0.79 to 1.53)
HR 0.96 (95% CI, 0.81 to 1.14)
While SSRI/SNRI use may appear to be associated with an increased risk of childhood seizures and epilepsy, this association disappears after adjusting for maternal indications of SSRI/SNRI use, parental background factors, and pregnancy specific characteristics
The authors state
The present study found no support for the concern that maternal SSRI/SNRI use in pregnancy increases children’s risk for neonatal seizures or epilepsy
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