Journal Article Annotations
2018, 1st Quarter
Annotations by Elizabeth Hovis, MD
Type of study: Cohort Study
The finding: Children of mothers using an SSRI in late pregnancy (> 29 weeks gestational age) had a greater risk of developing anxious or depressed behaviors by age 5 relative to those who were unexposed (95% CI: 0.04-0.96); however this is confounded significantly by indication, illness severity, and postnatal environment. The increased risk appeared to increase with age, reaching a significant effect at age 5 years old or greater. The observed risk was of medium magnitude corresponding to an odds ratio of 2.5 (8 children would be expected to have this behavioral problem for every 100 women treated with an SSRI in late gestation). Such risk was not observed in children exposed to SSRIs in early (0-16 weeks) or mid (17-28 weeks) pregnancy. There was no significant effect on externalizing behaviors and no increased risk for more problematic temperament in terms of emotionality, sociability, activity, or shyness.
Relevance: SSRI use in pregnancy is common, reaching 1-4% in Europe and up to 8% in the United States. Unfortunately, there is inconsistent evidence pertaining to the effects of prenatal SSRI exposure on behavioral outcomes in children. Taking into account the impact that childhood social, emotional and behavioral problems can have on psychiatric disorders later in life, it is important to better understand the role of potential risk factors, such as prenatal SSRI exposure, though these studies are significantly confounded by maternal illness state and severity. This is the first study to examine the time-dependent effect of prenatal SSRI exposure on behavioral, emotional, and social outcomes in preschool-age children. While the observed association must be confirmed by future research, this study may provide some insight into potentially important periods of fetal vulnerability to SSRI exposure and, in turn, may prove clinically useful in assisting physicians when evaluating the risk of treatment with an SSRI during pregnancy. Confounding by indication, severity, and genetics makes research in these areas challenging and conclusions must be drawn with caution.