Developing Minds

Antidepressant Use During Pregnancy Not Associated With Neurodevelopmental Risk in Children

Children who were exposed to antidepressants in the womb do not appear to have an increased risk of neurodevelopmental disorders, according to a report published today in JAMA Internal Medicine.

Elizabeth Suarez, M.P.H., Ph.D., of Harvard Medical School and colleagues used national public and private health insurance databases to compile information on mothers who filled a prescription for an antidepressant medication during the second half of pregnancy (a period of marked fetal brain development). The total sample included over 145,000 women who took an antidepressant during the second half of pregnancy and over 3 million who did not. The children of these women were tracked from birth until they were diagnosed with a neurodevelopmental disorder, died, disenrolled, or reached age 14.

The researchers specifically focused on the rates of the following neurodevelopmental disorders in the children: autism spectrum disorder, attention-deficit/hyperactivity disorder, learning disorder, speech or language disorder, developmental coordination disorder, intellectual disability, and behavioral disorder.

Overall, children who were exposed to any antidepressants had a 1.76-fold increased risk of being diagnosed with any neurodevelopmental disorder; this risk was similar regardless of the class of antidepressants taken by the mother (selective serotonin reuptake inhibitors, serotonin norepinephrine uptake inhibitors, and tricyclics), Suarez and colleagues reported. The risk of neurodevelopmental disorders in the children was also similar when limiting the comparison to those whose mothers took sertraline, fluoxetine, bupropion, citalopram, or escitalopram.

However, when the researchers adjusted for multiple variables, including the maternal mental health diagnoses, sociodemographic factors, and lifestyle behaviors (such as smoking and drinking), they found that the neurodevelopmental risk associated with antidepressants dropped to 1.15-fold increased risk of any disorder. The risk was even lower when comparing women who took antidepressants during pregnancy with women who stopped taking antidepressants shortly before pregnancy.

Finally, Suarez and colleagues compared families in which some siblings had been exposed to antidepressants while others had not. There was no evidence of increased risk from antidepressant exposure for any neurodevelopmental disorder when comparing these groups, they reported.

“The results of this cohort study suggest that antidepressant use in pregnancy itself does not increase the risk of neurodevelopmental disorders in children,” Suarez and colleagues concluded. “However, given strong crude associations, antidepressant exposure in pregnancy may be an important marker for the need of early screening and intervention.”

Exposure to Cannabis in Womb Associated With Behavioral Issues in Tweens, Study Finds

Children who were exposed to cannabis in the womb appear to be at a heightened risk of behavioral problems into at least early adolescence, suggests a report published Monday in JAMA Pediatrics. The findings—which are based on data collected as part of the Adolescent Brain and Cognitive Development Study (ABCD Study)—add to a growing body of evidence about the risks of cannabis use during pregnancy.

According to a media release from the National Institute on Drug Abuse, cannabis use among pregnant women increased from 3% in 2002 to 7% in 2017. In 2018, 4.7% of pregnant women reported cannabis use; 5.4% reported cannabis use in 2019.

A 2020 study by Ryan Bogdan, Ph.D., of Washington University in St Louis and colleagues found that children whose mothers used cannabis after learning they were pregnant were slightly more likely to have sleep, attention, and social problems at ages 9 and 10, among other issues. To determine if these associations remained as the children grew older, David A.A. Baranger, Ph.D., Bogdan, and colleagues followed up with these youth one and two years later. (As was done in the 2020 study, children and caregivers provided feedback on the Child Behavior Checklist and the Prodromal Questionnaire–Brief Child Version.)

The analysis included 10,631 individuals and 30,091 longitudinal assessments (baseline: n = 10,624; mean age, 9.9 years; one-year follow-up: n = 10,094; mean age, 10.9 years; two-year follow-up: n = 9,373; mean age, 12.0 years). The analysis revealed no significant changes in the rate of psychiatric conditions as the children aged.

“[Prenatal cannabis exposure] is associated with persisting vulnerability to broad-spectrum psychopathology as children progress through early adolescence,” Baranger and colleagues wrote. “Increased psychopathology may lead to greater risk for psychiatric disorders and problematic substance use as children enter peak periods of vulnerability in later adolescence.”

For related information, see the Psychiatric News article “Exposure to Alcohol, Cannabis in Womb Can Have Long-Term Consequences.”