Antidepressant Exposure In Utero Should Prompt Early Screening for Neurodevelopmental Disorders

Antidepressants use during pregnancy does not necessarily increase risk for neurodevelopmental disorders (NDDs) in children, but it may be an indication that children exposed to antidepressants in utero should be screened early for NDDs. These study findings were published in JAMA Internal Medicine.

Researchers from Brigham and Women’s Hospital in the United States sourced data for this study from the Medicaid Analytic eXtract (MAX) database and MarketScan Commercial Claims Database (MarketScan) that was collected between 2000 and 2015. Pregnant women (MAX: n=93,069; MarketScan: n=52,633) who had filled prescriptions for bupropion, citalopram, escitalopram, fluoxetine, or sertraline during pregnancy formed the antidepressant-exposed cohort. Pregnant women (MAX: n=1,833,927; MarketScan: n=1,198,818) who did not fill an antidepressant prescription within 90 days of the start of their pregnancy through delivery formed the comparator control group.

The primary outcome was prevalence of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), behavioral disorder, developmental coordination disorder, developmental speech or language disorder, intellectual disability, any NDDs, and specific learning disorders among the children of the women in the study cohorts.

Women were mean age 24.3 to 32.7 years and 10.1% to 20.3% had an Obstetric Comorbidity Index (OCI) score of at least 3. Among the antidepressant-exposed groups, the most common indications for antidepressant use were depression and anxiety and 76.9% to 87.0% of these participants were not taking other psychiatric medications.

The crude prevalence of NDDs by 12 years of age was higher among the children exposed to antidepressants in utero in the MAX (46.8% vs 31.4%) and MarketScan (24.9% vs 15.1%) datasets, respectively. The most common NDD was ADHD (17.6%-33.3% vs 9.6%-20.3%) among the exposed and unexposed groups, respectively.

In the unadjusted analysis, antidepressant exposure was assoicated with increased risk for any NDDs (hazard ratio [HR], 1.76), ADHD (HR, 2.02), behavioral disorders (HR, 1.96), ASD (HR, 1.81), developmental speech and language disorders (HR, 1.60), developmental coordination disorders (HR, 1.50), intellectual disabilities (HR, 1.41), and specific learning disabilities (HR, 1.32).

After adjusting for cofounders and high-dimensional propensity scores, antidepressant exposure remained a predictor for any NDDs (adjusted HR [aHR], 1.15), ADHD (aHR, 1.19), developmental coordination disorders (aHR, 1.15), behavioral disorders (aHR, 1.14), and developmental speech and language disorders (aHR, 1.12).

In the sibling analysis, antidepressant exposure was not a significant predictor for any NDD outcomes.

Stratified by drug class, similar findings were observed between medications, except that aHRs tended to be higher for escitalopram than other drug classes. Stratified by timing of antidepressant exposure, results were similar between the main analysis and the subset of women with antidepressant prescriptions during early pregnancy.

The study may have been limited by using antidepressant pharmacy prescriptions as a proxy for in utero antidepressant exposure.

Study authors concluded, “Results of this cohort study suggest that antidepressant use in pregnancy does not increase the risk of NDDs in children. However, elevated crude cumulative incidence estimates for NDDs suggest that antidepressant use by pregnant individuals is a robust marker of NDD risk in children.”

This article originally appeared on Psychiatry Advisor