Antidepressants in Pregnancy: Is Excess Risk for Autism Spectrum Disorder Believable?

Journal Watch Psychiatry editor, Allison Bryant, MD, MPH, reviewed a recent article on this topic Boukhris T et al. JAMA Pediatr 2015 Dec 14.

In this study the risk for autism spectrum disorder appeared to be higher in those women who used antidepressants (especially SRIs) during late pregnancy; but the question is whether maternal depression (the condition that would lead to treatment with an SRI) was the cause or whether it was the SRI itself.

Researchers from Canada used data from a population-based registry to examine the relationships between maternal antidepressant use during pregnancy and autism spectrum disorders in children.

Among >145,000 full term singleton infants, 0.7% had a diagnosis of ASD sometime between birth and the end of the follow-up period (average follow up of 6 years).

This is the summary of the study:

After accounting for measured potential confounders (maternal sociodemographic characteristics, history of maternal psychiatric and physical conditions, and infant characteristics), maternal antidepressant use during the second or third trimester was associated with increased risk for ASD in offspring (adjusted hazard ratio, 1.9; 95% confidence interval, 1.2–3.0). Risk was most pronounced for women who used selective serotonin re-uptake inhibitors rather than other types of antidepressants, and the findings persisted when the population was restricted to mothers with histories of depression.

COMMENT

Dr. Bryant takes exception to the author’s conclusions –

I am troubled by the authors’ assertion of adjustment “for all potential confounders.” It’s simply not possible outside of a randomized controlled trial (clearly not feasible here) to extricate the effects of a treatment from the potential effects of the condition necessitating treatment. In particular, the study’s methodology could not control for severity of maternal psychiatric disease; confounding by indication is almost certainly at play. In our current healthcare environment, where access to comprehensive mental health treatment can be challenging at best, I will continue to be reluctant to recommend cessation of antidepressant therapies for reproductive-aged women with otherwise poorly controlled depressive disorders.

References

Boukhris T et al. Antidepressant use during pregnancy and the risk of autism spectrum disorder in children. JAMA Pediatr 2015 Dec 14; [e-pub]. (http://dx.doi.org/10.1001/jamapediatrics.2015.3356)

For more information

Do Maternal Antidepressants Cause Autism

Depression in Pregnancy Affects the Child

Pregnancy and Mental Health