This Month in Psychopharmacology

Perinatal Antidepressant Use and Psychiatric Disorders in Offspring

A recent Danish cohort study examined the association between in utero exposure to antidepressants and risk of psychiatric disorders. A total of 905, 383 singletons were followed from birth until date of first psychiatric diagnosis for a maximum of 16.5 years. Children were categorized into four groups according to maternal antidepressant use within two years before and during pregnancy: 1) unexposed, 2) antidepressant discontinuation (use before but not during pregnancy), 3) antidepressant continuation (use both before and during pregnancy), and 4) new user (use only during pregnancy). Psychiatric disorders were diagnosed in 32,400 children. The adjusted 15-year cumulative incidence of psychiatric disorders was 8.0% (95% confidence interval 7.9% to 8.2%) in the unexposed group, 11.5% (10.3% to 12.9%) in the antidepressant discontinuation group, 13.6% (11.3% to 16.3%) in the continuation group, and 14.5% (10.5% to 19.8%) in the new user group.

Results suggest that in utero exposure to antidepressants was associated with increased risk of psychiatric disorders. The associations could be attributable to the severity of the underlying maternal disorders in combination with in utero antidepressant exposure. Children whose mothers discontinued antidepressant use had an increased risk of psychiatric disorders, most likely due to the maternal psychiatric disorders being transmitted to offspring via shared genetic susceptibility, environmental stress, and/or parenting practices. Children exposed to antidepressants in utero also had an increased risk of psychiatric disorders, most likely due to the severity of underlying maternal psychiatric disorders. Mothers with severe symptoms are more likely to continue treatment during pregnancy. Future research is needed to better illuminate the relationship between perinatal antidepressant use and psychiatric disorders in offspring.

References

Liu X, Agerbo E, Ingstrup KG, et al. Antidepressant use during pregnancy and psychiatric disorders in offspring: Danish nationwide register based cohort study. BMJ. 2017;358:j3668.