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Antidepressant use in pregnancy comes more into focus
James Keagy 15

Antidepressant use in pregnancy comes more into focus

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Antidepressants

Loren Bonner

Studying antidepressant use in pregnancy has led to an abundance of research, but without many answers. A large study recently published October 3, 2022, in JAMA Internal Medicine could hopefully offer some clarity—or at least add to the growing body of literature.

Researchers from Brigham and Women’s Hospital and Harvard Medical School found that antidepressant use during pregnancy does not seem to increase the risk of neurodevelopmental disorders in children.

“While exposure to antidepressants in pregnancy may indicate that a child is at greater risk for neurodevelopmental disorders, our results provide evidence that it’s not the antidepressant that is increasing the risk, but instead other factors associated with antidepressant use,” said lead author Elizabeth Suarez, MPH, PhD.

Antidepressant use in pregnancy comes more into focus

The research team found that children exposed to antidepressants in utero had double the incidence of ADHD compared to children not exposed to antidepressants. “But our results show this likely isn’t because of the antidepressant,” said Suarez, who is now a faculty member at the Center for Pharmacoepidemiology and Treatment Science at the Rutgers Institute for Health, Health Care Policy and Aging Research in New Jersey. She said other factors related to antidepressant use—including the indication for the antidepressant, such as depression or anxiety, health and lifestyle considerations associated with depression and anxiety, or genetic and environmental causes, are probably responsible for the doubling risk of ADHD.

“Our study wasn’t designed to determine what the true causal factor is, but it was striking to see this large difference in neurodevelopmental disorders,” she said.

Once the researchers accounted for confounding, the potential increases in risk for neurodevelopmental disorders after antidepressant use in pregnancy almost disappeared.

The researchers used two large health care databases with data on publicly and privately insured pregnant individuals and their infants in the United States. A total of 1.93 million pregnancies from one database and 1.25 million pregnancies in another database were recorded. Children were followed from birth until outcome diagnosis, disenrollment, death, or end of study. The research team analyzed the data between August 2020 and July 2021.

Results were generally consistent for antidepressant classes and drugs and across exposure windows, too.

Counseling

“Every decision to continue or start a medication in pregnancy is a balancing of risks and benefits,” said Suarez. “We believe these results indicate that neurodevelopmental disorders are likely not a major risk to be concerned about when counseling pregnant patients on whether to use antidepressants in pregnancy.” The American Psychiatric Association, along with the American College of Obstetricians and Gynecologists, advise women currently on medication for depression to always discuss with their health care provider the risks and benefits of staying on medication.

Potential risks of not treating depression during pregnancy include maternal suicide, inadequate prenatal care, poor maternal weight gain leading to low birthweight, risk of premature birth, marital or relational discord, and increased prenatal stress in the mother, which has been linked to effects on infant brain plasticity and cognition.

Study context

Several studies have attempted to clarify whether antidepressant exposure in utero increases the risk of neurodevelopmental disorders in children. Most of this research
to date has focus-ed on risks for ADHD and autism spectrum disorder.

“There was a lot of prior research in this area, but most of the results had been conflicting,” said Suarez. Whether antidepressant exposure increases the risk of these childhood disorders remains controversial.

What makes their study stand out, according to Suarez, is its size.

“Our study was much larger than previous studies, allowing us to present results with a greater degree of precision. We also addressed confounding in multiple ways. Because of this, we believe our study is a  valuable addition to existing evidence,” Suarez said.

She noted that results of their study generally agree with other research that appropriately addressed confounding by the indication for the antidepressant, such as anxiety or depression.

They controlled for confounding by indication, environment, and genetics through various design and analytic approaches. ■

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