Autism and Maternal Use of Antidepressants in Pregnancy

New info from JAMA on maternal depression and pregnancy
New info from JAMA on maternal depression and pregnancy

There’s a new study out about  antidepressant use during pregnancy and the risk of autism spectrum disorder (ASD) in children. Here’s the article in the LA Times; here’s an abstract of the original article in Journal of the American Medical Association.

From the LA Times article, by Melissa Healy:

The new findings emerged from a Canadian registry of 145,456 newborn children who were followed for an average of about six years. The ­medical records of the babies’ mothers were available for at least a year before their birth, allowing researchers to look at whether and when the babies’ pregnant mothers took selective serotonin reuptake inhibitors — SSRIs that include medications marketed as Prozac, Zoloft and Lexapro.

In the population as a whole, 0.7 percent of the registered babies (1,054) later received an autism diagnosis. Among the 2,532 babies whose mothers took an SSRI during her second and/or third trimester of pregnancy, 31 infants (or 1.2 percent) would receive an autism diagnosis some time in his or her first six years of life. Some 40 babies (1 percent) whose mothers took an SSRI in her first trimester of pregnancy were eventually diagnosed with autism.

In other words, nearly twice the risk of ASD in children whose mothers took SSRI’s in the 2nd and 3rd trimesters of pregnancy.

Conclusions and relevance, from the JAMA study:

Use of antidepressants, specifically selective serotonin reuptake inhibitors, during the second and/or third trimester increases the risk of ASD in children, even after considering maternal depression. Further research is needed to specifically assess the risk of ASD associated with antidepressant types and dosages during pregnancy.

So what does that mean, “even after considering maternal depression”?

Again, from the LA Times article:

A mother’s history of depression has long been suspected of raising a child’s autism risk. So the study also sought to clarify which showed a stronger link to a child’s likelihood of having autism: a mother’s depression or her taking SSRIs.

The researchers compared rates of autism among babies born to women with a history of depression with autism rates among babies born to those who took antidepressants during pregnancy. They found that babies whose mothers took an SSRI were still about 75 percent more likely to get an autism diagnosis than were those whose mothers had a history of depression.

So: maternal depression itself appears to increase the risk of autism in a child, and now there’s very good evidence–almost twice the incidence of ASD in children whose mothers used SSRI’s in the 2nd and 3rd trimesters of a pregnancy–that antidepressant use increases that risk, too.

OK, so before we panic, let’s look at this: We’re talking about the 2nd and 3rd trimesters of a pregnancy. Most women know they’re pregnant by then. Theoretically, SSRI use could be curtailed, or eliminated. Yes, I get that’s not as simple a statement as it seems, but nothing about this issue is simple.

One of my fears is that this discussion–which is what we need to have, what women and their obstetrician-gynecologists, women and their mental health professionals, women and their children’s pediatricians need to have–will be shut down by people worried about shaming depressed pregnant women, or depressed women who plan to get pregnant. There is no intent, here, to shame anyone. This is science, a scientific study that comes to some conclusions we all need to consider. No one’s being blamed, for depression or autism.

And neither does anyone have all the answers. What we do have is new and useful potentially useful scientific information about maternal depression, antidepressant use in later pregnancy, and autism in children. Let’s not blame or shame; let’s talk.

 

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