Maternal depression and antidepressant use during pregnancy and the risk of autism spectrum disorder in offspring

Abstract

BackgroundResults of some studies suggest that prenatal antidepressant exposure increases the risk of autism spectrum disorder (ASD) in offspring, while other studies suggest that depression independently increases the risk of having a child with ASD. Thus, confounding by indication is a concern.ObjectiveThe aim of this study was to estimate the risk of ASD in offspring of women who were exposed to antidepressants and/or had depression during pregnancy compared to unexposed women.Materials and methodsWe conducted a cohort study with nested sibling case–control analysis. Using the UK Clinical Practice Research Datalink (CPRD), we identified mother– baby pairs where the mother had ≥12 months of history before the delivery date and the child had ≥3 years of follow-up. Exposures during pregnancy were classified as 1) depression treated with antidepressants, 2) untreated depression, 3) other indications for antidepressant use, and 4) 4:1 match of unexposed women with no history of depression or antidepressant use. We calculated the prevalence of ASD and relative risk (RR) with 95% CI. In the sibling analysis, we compared exposure among ASD cases to that of non-ASD siblings born to the same mother. We calculated ORs and 95% CIs for women with treated and untreated depression, compared to unexposed.ResultsWe identified 2,154 offspring with ASD among 194,494 mother–baby pairs. Compared to unexposed, the RR of ASD was 1.72 (95% CI 1.54–1.93) for treated depression and 1.50 (95% CI 1.28–1.75) for untreated depression, while the RR was not elevated in women who received antidepressants for other indications (RR =0.73, 95% CI 0.41–1.29). Additional analyses to assess the effects of severity of depression suggest that the risk of ASD in offspring increases with increasing severity, not with the antidepressant treatment. The results of the sibling analysis were similar to the main analysis.ConclusionWomen with depression during pregnancy have an increased risk of having a child with ASD, regardless of antidepressant use.

Associations between macrolide antibiotics prescribing during pregnancy and adverse child outcomes in the UK: population based cohort study

“…Prescription data are automatically recorded when prescriptions are issued 16. In the UK, general practices are the main point of contact for non-emergency medical care, including pregnancy, and CPRD has been extensively used in pharmacoepidemiology studies in pregnancy 17181920. We report our findings according to the REporting of studies Conducted using Observational Routinely collected Data (RECORD) guideline (supplementary table S1) 21…”

Third-party prosocial behavior in adult female rats is impaired after perinatal fluoxetine exposure

“…Some studies show a clear correlation between SSRI treatment and increased odds for ASD in the offspring [13][14][15][16][17], whereas others did not find this link or suggest that this increased risk is caused by the depression itself rather than the SSRIs [18,19]. The mothers who do take antidepressants during pregnancy most likely suffer from a more severe depression, and untreated depression during pregnancy may also have negative impact on the offspring [18,[20][21][22][23]. In fact, when controlled for maternal mood and stress, the link between antenatal SSRI use and the occurrence of ASD in the offspring does not persist [24].…”

Immuno-psychiatrie et pandémie de SARS-CoV-2 : liens et possibles conséquences

“…Une étude portant sur 37 enfants dont les mères étaient enceintes lors de la tempête de verglas de 1998 au Québec, a montré des altérations immunitaires chez les enfants âgés de 13 ans, proportionnelles au degré objectif de stress vécu par les mères pendant leur grossesse [28] . Une étude de cohorte récente, portant sur 2154 enfants avec TSA nés entre 1989 et 2011, a objectivé une augmentation du risque de TSA chez l’enfant en cas de dépression maternelle au cours de la grossesse [29] . Le risque de TSA chez l’enfant était discrètement plus élevé pour les mères souffrant de dépression, traitées par antidépresseurs (risque relatif = 1,72), par rapport aux mères souffrant de dépressions non traitées par antidépresseurs (risque relatif = 1,50).…”

“…Cependant, pour les femmes traitées par antidépresseur pour une raison autre que la dépression, le risque de TSA chez l’enfant n’était pas plus élevé (risque relatif = 0,73), suggérant que c’est bien la dépression, et non les antidépresseurs, qui est associée au risque de TSA. La légère augmentation du risque de TSA pour les enfants de mères souffrant de dépression, traitées par antidépresseur, par rapport aux mères non traitées, serait possiblement associée à une sévérité plus importante de la dépression [29] .…”