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 The overall risk is low, though. Only about 3 percent of the nearly
905,383 children in the study were diagnosed with a psychiatric
disorder by age 16.
But compared to the children of women who took antidepressants
before pregnancy but not during, kids whose mothers continued taking
the medications in pregnancy were 27 percent more likely to be
diagnosed with mood, anxiety, behavioral or autism spectrum
disorders.
Lead author Xiaoqin Liu, an epidemiologist at the National Center
for Register-based Research at Aarhus University in Denmark, said
the study is the first to look at a wide range of psychiatric
disorders, instead of a single psychiatric illness, among children
exposed to antidepressants in utero.
The results are in line with some past research, but conflict with
other studies, Liu noted. This could be due to differences in study
population and sample size, or alternatively, the potential
association is modest, he said.
“We would like to stress that our study does not suggest or support
that women with depression discontinue medication during pregnancy,”
he told Reuters Health by email.
Some past research has also found that the children of women with
untreated depression during pregnancy have a higher risk of
psychiatric disorders and other health issues, raising the question
of how much of a child’s risk is tied to the mother’s underlying
mental illness and how much to the medications she takes to treat
it.
Liu’s team used birth and health registries to follow children born
in Denmark between 1998 and 2012 until July 2014, for a maximum of
about 16 years of follow-up. They found that almost twice as many
children, or 14.5 percent, were diagnosed with a psychiatric illness
if their mother began antidepressants during pregnancy compared with
8 percent whose mothers never used these medications.
The incidence of psychiatric disorders in children whose mothers
started using antidepressants during pregnancy was 14.5 percent,
among those whose mothers continued prior use of the medications
during pregnancy it was 13.6 percent, and when mothers discontinued
the medications before pregnancy, it was 11.5 percent.
Overall, the risk of psychiatric disorders in children born to
mothers who began using antidepressants during pregnancy was 56
percent higher compared to those whose mothers had never used the
drugs, and 64 percent higher when mothers continued antidepressant
use during pregnancy, according to the results published in The BMJ.
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“On the one hand I believe studies using this type of method can be
really important for generating hypotheses, but they are really
poorly suited for actually testing the hypothesis. To me this study
doesn’t bring us any closer to finding an actual answer,” said Dr.
Michael Schoenbaum, senior advisor for mental health services,
epidemiology and economics at the U.S. National Institute of Mental
Health who wasn’t involved in the research.
“I think that what it is likely to do is make people nervous.
Depression is a serious thing. Untreated, it’s dangerous to a mother
and child,” Schoenbaum told Reuters Health in a phone interview.
The risk of psychiatric disorders in children did not vary by class
of antidepressant a mother used, but the highest risk was among
children exposed to both selective serotonin reuptake inhibitors (SSRIs)
and non-SSRI antidepressants during pregnancy.
Liu and colleagues also found that antidepressants prescribed during
the second or third trimester, or over more than one trimester,
posed a higher risk of psychiatric disorders.
Psychiatric illnesses are under-reported and registries don’t often
collect information about substance abuse and drinking, noted Dr.
Kimberly A. Yonkers of the Yale School of Public Health in New
Haven, Connecticut, who wasn’t involved in the study.
At most, Yonkers said, the study reinforced the heritability of mood
disorders by also exploring paternal exposure to antidepressants.
In an editorial accompanying the study, researchers from the
PharmacoEpidemiology and Drug Safety Research Group at University of
Oslo in Norway point out that only “the most severely sick women
have drugs prescribed in pregnancy.” Comparing this group to women
who discontinued antidepressants helps to “disentangle” the effects
of the drugs from the mother’s underlying illness.
SOURCE: http://bit.ly/2j5coBO and http://bit.ly/2y6rGJY The BMJ,
online September 6, 2017.
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