In a recent cohort study, the relationship between in utero exposure to antidepressants and increased risk of neurodevelopmental disorders was examined. A total of 1.93 million pregnancies from a research database that examined two cohorts of publicly insured (Medicaid analytic eXtract; MAX 2000-2014) and privately insured (IBM MarketScan Research Database (MarketScan; 2003-2015). Children were followed from birth until diagnosis, disenrollment, death, or end of study (maximum 14 years). Analyses were conducted between August 2020 and July 2021. Among those included in the analysis, there were 145702 antidepressant-exposed and 3032745 unexposed pregnancies; the mean (SD) age among the antidepressant-exposed. Crude results suggested up to a doubling in risk of neurodevelopmental outcomes associated with antidepressant exposure; however there was no association observed in the most fully adjusted analyses. Early pregnancy exposure was included in sensitivity analyses, and approaches to confounding adjustment included propensity score fine stratification, discontinuers, and sibling analyses. When comparing antidepressant-exposed and unexposed siblings, hazard ratios were 0.97 (95% CI, 0.88-1.06) for any neurodevelopmental disorder, 0.86 (95% CI, 0.60-1.23) for autism spectrum disorder, 0.94 (95% CI, 0.81-1.08) for attention-deficit/hyperactivity disorder, 0.77 (95% CI, 0.42-1.39) for specific learning disorders, 1.01 (95% CI, 0.88-1.16) for developmental speech/language disorder, 0.79 (95% CI, 0.54-1.17) for developmental coordination disorder, 1.00 (95% CI, 0.45-2.22) for intellectual disability, and 0.95 (95% CI, 0.80-1.12) for behavioral disorders. The results were generally consistent for antidepressant classes and across exposure windows. The results of this study suggest that antidepressant use in pregnancy does not increase the risk of neurodevelopmental disorders in children. However, the strong crude associations reported suggest that antidepressant exposure in pregnancy may be an important marker for the need of early screening and intervention.

Reference:

: Suarez EA et al. JAMA Network 2022; 182(5):522-533. Abstract.