Rate of Chiari I Malformation in Children of Mothers with Depression with and without Prenatal SSRI Exposure

Abstract

Selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed to pregnant women. Therefore, research on in utero exposure to SSRIs can be helpful in informing patients and clinicians. The aim of this retrospective two-cohort study was to determine whether there is a statistically significant increase in Chiari I malformations (CIM) in children exposed to SSRIs during pregnancy. A total of 33 children whose mothers received a diagnosis of depression and took SSRIs during pregnancy (SSRI-exposed cohort) were matched to 66 children with no history of maternal depression and no SSRI exposure. In addition, 30 children whose mothers received a diagnosis of depression, but did not receive antidepressants during pregnancy (history of maternal depression cohort), were matched to 60 children with no history of maternal depression and no SSRI exposure. Main outcome was presence/absence of CIM on MRI scans at 1 and/or 2 years of age. Scans were reviewed by two independent neuroradiologists who were blind to exposure status. The SSRI-exposed children were significantly more likely to be classified as CIM than comparison children with no history of maternal depression and no SSRI exposure (18% vs 2%, p ¼ 0.003, OR estimate 10.32, 95% Wald confidence limits 2.04-102.46). Duration of SSRI exposure, SSRI exposure at conception, and family history of depression increased the risk. The history of maternal depression cohort did not differ from comparison children with no history of maternal depression and no SSRI exposure in occurrence of CIM (7% vs 5%, p ¼ 0.75, OR estimate 1.44, 95% Wald confidence limits 0.23-7.85). Replication is needed, as is additional research to clarify whether SSRIs directly impact risk for CIM or whether this relationship is mediated by severity of depressive symptoms during pregnancy. We would discourage clinicians from altering their prescribing practices until such research is available.

Antenatal depression, treatment with selective serotonin reuptake inhibitors, and neonatal brain structure: A propensity-matched cohort study

“…Participants were drawn from three prospective longitudinal neuroimaging studies being carried out at UNC (Gilmore et al, 2010; Gilmore et al, 2012; Knickmeyer et al, 2014). Recruitment occurred through community physicians, relevant clinics at UNC, including the perinatal psychiatry clinic and general obstetrics clinics, and mass emails to the UNC community.…”

“…One study reported benign caudothalamic cysts in 6 of 40 at term infants exposed to SSRIs but no unexposed comparison group was evaluated (Laine et al, 2003). We recently reported that children exposed to SSRIs prenatally exhibit a striking increase in Chiari I malformations, a condition resulting from the underdevelopment of the posterior cranial fossa and overcrowding of the normally developing hindbrain (Knickmeyer et al, 2014). The current study is the first to examine brain tissue volumes and white matter development of SSRI-exposed neonates.…”

Functional Connectivity Disruption in Neonates with Prenatal Marijuana Exposure

“…Human brain imaging studies show that functional network activity underlies the typical cognitive and behavioral processes reportedly altered by PME, and that aberrant connectivity is linked to atypical functional development in other disorders (Bressler and Menon, 2010 ; Insel, 2010 ). A small number of research groups have begun to document how and when these functional networks develop in typical neonates (Lin et al, 2008 ; Gao et al, 2009 ; Fransson et al, 2013 ), and have shown that prenatal exposure to other psychoactive drugs alters early structure (Grewen et al, 2014 ; Knickmeyer et al, 2014 ) and connectivity (Salzwedel et al, 2015 ). Animal studies show prenatal THC-induced disruption of neural connectivity that results in long-lasting alterations in structure and function of cortical circuitry (Tortoriello et al, 2014 ).…”

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

“…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].…”