Antidepressant exposure in pregnancy and risk of autism spectrum disorders

Sørensen, Merete Juul; Grønborg, Therese Koops; Christensen, Jakob; Parner, Erik Thorlund; Vestergaard, Mogens; Schendel, Diana; Pedersen, Lars Henning

doi:10.2147/clep.s53009

Cited by 152 publications

(185 citation statements)

References 54 publications

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“…[67][68][69] Recently, some investigations have found an association between autism and prenatal antidepressant exposure, 70,71 while other large-scale studies have failed to detect such a connection. 72,73 Further research into this correlation is needed.…”

Section: Antidepressantsmentioning

confidence: 99%

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Misri

Abizadeh

Sanders

et al. 2015

Journal of Women's Health

102

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Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum.

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Section: Antidepressantsmentioning

confidence: 99%

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Misri

Abizadeh

Sanders

et al. 2015

Journal of Women's Health

102

View full text Add to dashboard Cite

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“…Most of the included studies point to a linkage between SSRIs and ASD, with almost all published studies pointing to increases in risk even if in individual studies the increase is not significant [68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83].…”

Section: Resultsmentioning

confidence: 99%

Links between serotonin reuptake inhibition during pregnancy and neurodevelopmental delay/spectrum disorders: A systematic review of epidemiological and physiological evidence

Healy

Noury

Mangin

2016

JRS

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Abstract. OBJECTIVE:To investigate possible linkages between neurodevelopmental delay and neurodevelopmental spectrum disorders and exposure to medication with effects on serotonin reuptake inhibition during pregnancy. METHODS: We systematically reviewed the epidemiological literature for studies bearing on this relationship in children born with neurodevelopmental spectrum disorder and related conditions, as well as animal studies giving serotonin reuptake inhibitors to pregnant animals and in addition reviewed the literature for proposals as to possible mechanisms that might link effects on serotonin reuptake with cognitive changes post-partum.The epidemiological studies were analysed to produce Forest plots to illustrate possible relations. RESULTS: The odds ratio of Autistic Spectrum or related Disorders in children born to women taking serotonin reuptake inhibiting antidepressants during pregnancy in case control studies was 1.95 (95% C.I. 1.63, 2.34) and in prospective cohort studies was 1.96 (95% C.I. 1.33, 2.90).CONCLUSIONS: There appears to be a link between serotonin reuptake inhibition in pregnancy and developmental delay and spectrum disorders in infancy leading to cognitive difficulties in childhood. More work needs to be done to establish more precisely the nature of the difficulties and possible mechanisms through which this link might be mediated.Keywords: Autism spectrum disorder, neurodevelopmental delay, neurodevelopmental spectrum disorders, antidepressants, serotonin reuptake inhibitors, pregnancy BackgroundThe clinical syndrome later called autism was first reported in 1943 [1]. The first studies of the prevalence of autism or autistic disorder (AD) in the 1960s pointed to a rate of 4 per 10,000 [2,3]. Later studies indicated the existence of a spectrum of disorders, and brought the term autistic spectrum disorder (ASD) into being in the mid-1990s 126 D. Healy et al. / Link between SSRIs in pregnancy and autistic spectrum disordersand ASD also now includes other syndromes such as Pervasive Developmental Disorder and Aspergers Disorder so that it is difficult to know how closely current clinical usage of an ASD diagnosis maps onto AD and ASD as first conceived. Current estimates are that ASD in research studies occurs at a rate of more than 1 in 70 children [5,6].Kanner autism was recognized before the emergence of modern psychotropic drugs, and given its submergence in ASD, it may not now be possible to establish whether it is linked to commonly used psychotropic medications. A number of clinical pictures linked to psychotropic drug use, fetal anticonvulsant syndrome (FACS), fetal valproate syndrome (FVS), and fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorder (FASD) have been described since 1970. Aside from the link to treatment, the clinical features of these disorders are consistent with a diagnosis of ASD but not Kanner autism. A growing number of epidemiological studies point to an increase in rates of ASD. This translates popularly into concerns about a change in the p...

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“…The cohort study by Boukhris et al is one of at least 5 papers since 2011 investigating antidepressant exposure and ASD. [1][2][3][4][5] They find -in contrast with the majority of prior reports -a risk increase from $0.7% to $1.2% among children of mothers treated with antidepressants. This result reflects a total of 31 children with ASD exposed to antidepressants during the second or third trimester.…”

Section: Adolescent Injury Prevention Programs Associated With Sportsmentioning

confidence: 99%

Adolescent injury prevention programs associated with sports-related injury reduction

Rößler

Faude

2016

The Journal of Pediatrics

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EDITOR'S NOTE: Studies for this issue were identified using the Clinical Queries feature of PubMed, "hand" searching JAMA Pediatrics, Pediatrics, and The Journal of Pediatrics, and from customized EvidenceUpdates alerts.EBM PEARL: PUBLICATION BIAS: Publication bias, one of the systematic review/meta-analysis-study methodologic validity issues, typically occurs when there is a nonrandom surplus of studies detecting, versus not detecting, statistical significance. Among reasons why "negative" studies may not be published, the most common are researchers and editors declining to publish negative studies. Conclusions drawn from publication-biased systematic reviews/meta-analyses tend to overestimate the effect size. Publication bias may be detected using both statistical and visual means. The funnel-plot method is a visual method, graphing the standard error of each study (y-axis) versus the effect size (x-axis), with higher standard error closer to the x-axis. The larger studies gather at the top of the plot and tend to group together close to the summary effect size. The smaller studies tend to have more scatter at the bottom of the plot. The result is an inverted funnel shape. If the funnel shape is not symmetric (missing some studies on the negative-result side), one presumes some studies were not published. Publication bias may be avoided by requiring registration prior to study initiation. The study by Soomro et al (see piece by R€ ossler and Faude on page 277 regarding Am J Sports Med (2015). pii: 0363546515618372) employed funnel-plot analysis to assess publication bias.LITERATURE SEARCH PEARL: DOCPHIN: Docphin (www.docphin.com) is a free, personalized healthinformation, RSS (really simple syndication)-type network, aggregating information from journals and news sites. The "phin" in Docphin stands for personalized health information network. Physicians developed Docphin in 2010, to cull useful, specialty-specific, up-to-date information from the vast and expanding medical literature. At sign up, users can choose specialty (pediatrics is included) and university. The latter has the advantage of oneclick access to full-length articles. If your university is not listed, you can request that Docphin add it. Docphin collects information from Twitter feeds and various news sites to keep you up-to-date on what your patients may be reading.- Roland R€ ossler, MSc

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Antidepressant exposure in pregnancy and risk of autism spectrum disorders

Cited by 152 publications

References 54 publications

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Links between serotonin reuptake inhibition during pregnancy and neurodevelopmental delay/spectrum disorders: A systematic review of epidemiological and physiological evidence

Adolescent injury prevention programs associated with sports-related injury reduction

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