Children born to women with reported use of selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitor (SNRIs) during pregnancy are at a greater risk for neonatal seizures and epilepsy largely due to background factors rather than the use of medication itself, according to study findings published in Neurology.
Previous studies have suggested that in the third trimester, the maternal use of SSRIs or SNRIs during pregnancy is associated with neonatal seizures. However, data on the effect of these medications on recurrent seizures (eg, epilepsy) in childhood are limited. The observed risk for seizures in childhood may be due to prenatal exposure to these medications or confounding maternal background factors.
The objective of the current study was to assess whether children born to women who use serotonergic antidepressants during pregnancy are at higher risk for seizures and epilepsy.
Researchers at Indiana University in Bloomington used data from the Medical Birth Register in Stockholm, Sweden, to examine the association between reported maternal use of SSRIs or SNRIs and the diagnosis of neonatal seizures or epilepsy in over 1.2 million children born from 1996 through 2013. Following the evaluation of the SSRI and SNRI use and parental epilepsy, researchers adjusted for a wide range of background factors (eg, age, education, and comorbidities) and pregnancy-specific characteristics (eg, maternal use of tobacco and use of other psychiatric medications).
The study found that the children born to women with reported use of SSRIs or SNRIs during pregnancy had 41% greater risk for newborn seizures (n=1,551,906; risk ratio [RR], 1.41; 95% CI, 1.03-1.94) and 21% increased risk for being diagnosed with epilepsy during follow-up (n=1,367,087; hazard ratio [HR], 1.21; 95% CI, 1.03-1.43) compared with children who were unexposed to SSRIs or SNRIs. In this study, neonatal seizures and epilepsy were classified using International Classification of Diseases (ICD)-9 and ICD-10. Neonatal seizures were defined by at least 1 diagnosis within the first 30 days of life and epilepsy was defined by at least 1 diagnosis at any time after birth.
The researchers adjusted for maternal indications for SSRI or SNRI use, such as mood and anxiety disorders (RR, 1.30; 95% CI, 0.94-1.80; HR, 1.13; 95% CI, 0.95-1.33), but did not adjust for family history of epilepsy. Further adjustments for all measured parental and pregnancy-specific factors attenuated remaining associations (RR, 1.10; 95% CI, 0.79-1.53; HR 0.96; 95% CI, 0.81-1.14).
The SSRI and SNRI exposure defined in this study was based on maternal self-reports in the first trimester and findings may not be generalizable to exposures in later pregnancy.
The present study observed that the elevated risk for neonatal seizures and childhood epilepsy in children who were exposed to SSRIs or SNRIs during pregnancy can be attributed to the indicated SSRI and SNRI use for pregnant women, history of parental epilepsy, and other covariates. Researchers did not find that maternal use of SSRIs and SNRIs directly increases a child’s epilepsy risk.
“Pregnancy is a trying time, and the addition of depression, anxiety, and other mental health conditions add to this burden. As such, these findings may provide respite and reassurance to women (and providers) considering the risks and benefits to medication treatment, especially those who do not have the time or resources to pursue nonpharmacologic treatment,” the researchers stated.
Disclosure: A study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Wiggs KK, Sujan AC, Rickert ME, et al. Maternal serotonergic antidepressant use in pregnancy and risk of seizures in children. Neurology. Published online May 11, 2022. doi:10.1212/WNL.0000000000200516