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Antidepressant use during pregnancy may cause psychiatric disorders in children

Stephen Padilla
14 Sep 2017

The use of antidepressants during pregnancy is likely to result in an increased risk of psychiatric disorders in offspring, suggests a recent study.

“This association may be attributable to the severity of underlying maternal disorders in combination with antidepressant exposure in utero,” researchers said. “Our findings suggest that focusing solely on a single psychiatric disorder among offspring in studies of in utero antidepressant exposure may be too restrictive.”

A total of 32,400 children were diagnosed with psychiatric disorders. The adjusted 15-year cumulative incidence of psychiatric disorders was 8.0 percent (95 percent CI, 7.9 to 8.2 percent) in the unexposed group, 11.5 percent (10.3 to 12.9 percent) in the antidepressant discontinuation group, 13.6 percent (11.3 to 16.3 percent) in the continuation group and 14.5 percent (10.5 to 19.8 percent) in the new user group. [BMJ 2017;358:j3668]

Moreover, participants in the antidepressant continuation group showed a greater risk of psychiatric disorders (hazard ratio, 1.27; 1.17 to 1.38) in offspring than those in the discontinuation group.

“We observed increased risks for psychiatric disorders among children of mothers who used antidepressants before and/or during pregnancy, compared with mothers with no record of antidepressant use,” researchers said. “Furthermore, we observed increased risk of psychiatric disorders in children whose mothers continued antidepressant use during pregnancy, compared with mothers who discontinued.”

Such association could be due to the severity of the underlying maternal disorders in combination with in utero antidepressant exposure. [J Clin Psychiatry 2011;358:979-85]

In addition, the association between discontinued antidepressant use and an increased risk of psychiatric disorders could be explained by the underlying maternal psychiatric disorders, which may be transmitted to offspring through shared genetic susceptibility, environmental stress and/or parenting success. [Arch Gen Psychiatry 2010;358:822-9; Arch Pediatr Adolesc Med 2006;358:279-84; Biol Psychiatry 2005;358:211-7]

“The decision to discontinue or maintain antidepressant treatment during pregnancy is challenging,” according to researchers.

Cessation of antidepressant use may result in psychiatric episodes with subsequent long-lasting adverse effects on both the mother and child. On the other hand, discontinuation of antidepressants might be a viable option for a subgroup of women. [Can J Psychiatry 2004;358:726-35; Obstet Gynecol 2009;358:703-13]

There are clinical guidelines available to identify these women who can be tapered off antidepressants, including a review from the American Psychiatric Association and the American Association of Obstetricians and Gynecologists. [Obstet Gynecol 2009;358:703-13]

“This review concludes that patients with no or mild depressive symptoms during a 6-month period may be candidates for discontinuation before conception. In contrast, patients with a history of severe, recurrent depression may not be suitable candidates for drug discontinuation before or during pregnancy,” researchers said.

“The findings of our study do not change these recommendations. Importantly, any final decision on antidepressant continuation should be individualized and made jointly by health professionals and patients,” they added.

In this population-based cohort study that investigated the association between in utero exposure to antidepressants and risk of psychiatric disorders, researchers identified a total of 905,383 liveborn singletons delivered during 1998 to 2012 in Denmark and followed them until July 2014, death, emigration or date of first psychiatric diagnosis, whichever came first. The children were followed for a maximum of 16.5 years and contributed 8.1×106 person-years at risk.

The participants were divided into four groups according to maternal antidepressant use within 2 years before and during pregnancy: unexposed, antidepressant discontinuation (use before but not during pregnancy), antidepressant continuation (use both before and during pregnancy) and new use (use only during pregnancy). The main outcome measure was first psychiatric diagnosis in children, defined as first day of inpatient or outpatient treatment for psychiatric disorders.

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