Based on the article “Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children,” published in the Journal of the American Medical Association (JAMA) Pediatrics recently, some news reports have suggested that antidepressant use during pregnancy increases the risk of autism in children. Specialists at Women & Infants Hospital and Butler Hospital, members of Care New England and affiliated with The Warren Alpert Medical School of Brown University, do not agree with the interpretation of the study.
The outcome of the trial has generated concerns and controversy in social media in the wake of its publication in drawing a potential link to development of autism in children whose mothers regularly took antidepressants and other selective serotonin reuptake inhibitors (SSRIs) while pregnant. “During…follow-up, 1,054 children (0.7%) were diagnosed with Autism Spectrum Disorder or ASD; boys with ASD outnumbered girls by a ratio of about 4-1,” said Takoua Boukhris, MSc, principal author on the study. Boukhris and his team from the University of Montreal concluded that the use of antidepressants, specifically selective SSRIs, during the second and/or third trimester, increases the risk of ASD in children.
At Women & Infants Hospital, clinicians and researchers who study maternal behavioral health and child development weighed in to put the relative risks of depression during pregnancy into context.
“Antidepressants are an extensively studied class of medication in pregnancy, and the overwhelming evidence is that untreated maternal depression can cause far greater risk to both the mother and the developing fetus,” said Margaret Howard, PhD, director of the Division of Women’s Behavioral Health and a clinical professor in the departments of Psychiatry and Human Behavior and Medicine at Brown University. “Depression untreated during pregnancy can lead to postpartum depression after delivery.”
“While this study points to an important risk indicator that requires a lot more research, the findings in this new study may be misleading. They do not fully take into account the severity of mothers’ depression, other factors such as alcohol or other substance use, unknown environmental toxins, or many other conditions that may impact fetal and child development, which have been shown to be higher in those taking antidepressants during pregnancy, ” added Neha Hudepohl, MD, fellowship director of the Brown University/Women & Infants Hospital Women’s Mental Health Fellowship, psychiatrist with the Center for Women’s Behavioral Health, and assistant professor of psychiatry and human behavior (clinical) at the Alpert Medical School of Brown University.
As Butler Hospital President and Research Psychiatrist Larry Price, MD, points out, “This is one of many epidemiological risk surveillance studies that have been published in the past few years examining the effects of antidepressants on the developing fetus. These studies, which are not always consistent in their findings, have demonstrated both risks and benefits, depending upon the perspective in which they are viewed. Unfortunately, it is in the nature of such studies, owing to their retrospective designs, that they will never be able to provide us with definitive answers to our concerns about fetal risk. What is clear at this point, the very modest increase in the risk for autism identified in this study, if true, always needs to be balanced against the very real risks of inadequately treated depression, risks that affect both the fetus and the mother.”
Speaking about child development, Stephen Sheinkopf, PhD, assistant professor of psychiatry and pediatrics at the Alpert Medical School, co-director of the Rhode Island Consortium for Autism Research & Treatment, and clinician at Women & Infants’ Brown Center for the Study of Children at Risk, agreed with Dr. Howard that the study leaves many questions unanswered.
“It is not clear that the findings are specifically related to antidepressants,” says Dr. Sheinkopf, who noted that chronic stress during pregnancy may have an impact, underscoring the importance of adequately treating depression during pregnancy. In addition, the number of cases with autism in the group of mothers treated with antidepressants remains small. “There is a concern that the reports about this study overstate the risks.”
Women & Infants recently published results of a trial in which researchers examined the effects of SSRIs, as well as no drug treatment for mom, with a focus on newborns. Principal Investigator Amy Salisbury, PhD, a research scientist at the Brown Center for the Study of Children at Risk and an associate professor of pediatrics and psychiatry at the Alpert Medical School, said, “Women who need treatment should continue to receive it; the risks to both mother and baby from highly symptomatic depression and/or anxiety have to balance against the risks of the treatment, which at this point, remain relatively small despite the new findings. The current recommendations are for women to not stop taking the medications just to prevent neurobehavioral problems for the baby at birth, as we did not find evidence that it prevents these signs.”
“As always,” Dr. Howard added, “women should talk directly with their obstetricians and psychiatric providers about their own personal risk before making any decisions to change or stop their treatment regimen for depression.”