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SSRI antidepressants and pregnancy: long-term neuropsychiatric disorders in exposed children?

FEATURED REVIEW Data available in 2017 suggested that in utero exposure to SSRI antidepressants increases the risk of autism. Do we have a clearer idea in 2020 of the long-term neuropsychiatric harms to the unborn child posed by the use of SSRI antidepressants during pregnancy?
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  • The evaluation data available in mid-2020 on the long-term risk of neuropsychiatric disorders in children exposed in utero to antidepressants mainly come from children exposed to so-called selective serotonin reuptake inhibitors (SSRIs). Evaluation of this risk is primarily based on a meta-analysis of about 15 epidemiological studies. The level of evidence is poor, due to heterogeneity in study methodology and in the handling of certain confounding factors, such as the parents' psychiatric history and the severity of the mothers' depression.
  • Compared with unexposed children, exposure was associated with a statistically significant increase in the risk of being diagnosed with autism or an autism spectrum disorder (about 50% more frequent) or hyperactivity (about 40% more frequent), especially in children exposed during the first or second trimester of pregnancy.
  • Exposed children had lower motor development scores according to this meta-analysis, but with no tangible clinical consequences. 
  • A Danish cohort study in about 21 000 children born between 1998 and 2012, then followed up until mid-2014, found a roughly threefold increased risk of mood disorders. 
  • In practice, the available data mainly pertain to SSRI antidepressants. Although the evidence is of low quality, it justifies exercising caution, informing the patients concerned about this potential risk, using non-pharmacological measures such as psychotherapy or physical activity first, and considering SSRI antidepressants only if the patient's disorders are resistant to these treatments or are so debilitating that drug therapy appears necessary.

©Prescrire 1 January 2021

Source: "SSRI antidepressants and pregnancy: long-term neuropsychiatric disorders in exposed children? (continued)" Prescrire International 2021; 30 (222): 16-18. Subscribers only.

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See also:

"SSRI antidepressants and
pregnancy: a link with autism?"
Prescrire Int 2017;
26 (186): 239-240.
Pdf, subscribers only

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