Columbia: Mothers who purchased antidepressants at least twice during pregnancy
had a 37-percent increased risk of speech and/or language disorders
among their offspring compared to mothers with depression and other
psychiatric disorders who were not treated with antidepressants,
according to new research. Results by scientists at Columbia University’s Mailman School of Public Health and Columbia University Medical Center are published online in JAMA Psychiatry.
“To
our knowledge, this is the first study to examine the relationship
between maternal antidepressant use and speech/language, scholastic, and
motor disorders in offspring. The study benefited from a large sample
population and followed the children beyond age 3,” said Alan Brown, MD, MPH, Mailman School of Public Health professor of Epidemiology and
Columbia professor of Psychiatry. The speech/language disorders
included expressive and receptive language disorders and those involving
articulation of sounds.
Selective serotonin reuptake inhibitors
(SSRIs) such as fluoxetine, citalopram, paroxetine, sertraline,
fluvoxamine, and escitalopram cross the placenta and enter the fetal
circulation. They are also increasingly used during pregnancy.
Based
on a sample of 845,345 single, live births between 1996 and 2010 taken
from national registries in Finland, the exposure groups were classified
as mothers who purchased SSRIs once or more before or during pregnancy
(15,596); those diagnosed with a psychiatric disorder one year before or
during pregnancy but did not purchase antidepressants (9,537); and
mothers who neither purchased antidepressants nor were given
depression-related diagnoses (31,207).
Since the extent of SSRI
exposure was greater for mothers with more than one SSRI purchase during
the pregnancy, Dr. Brown and colleagues also examined exposure by
number of purchases (one, two, or more), and conducted two supplemental
analyses to determine whether associations between maternal purchases of
two or more SSRIs and the risk of speech/language disorders in
offspring were further affected by the severity of depression. The
results did not change appreciably and remained statistically
significant.
“We believe that ourfinding about children of
mothers who purchased at least two SSRI prescriptions during pregnancy
is particularly meaningful because these women are more likely to have
taken these medications, and more likely to have been exposed for a
longer period and to larger amounts of the SSRI in pregnancy, compared
to women who filled only one prescription,” noted Dr. Brown. However, in
the whole sample, irrespective of number of purchases, the risk of
speech/language disorders was increased among offspring of mothers who
used SSRI during pregnancy as well as the offspring of mothers with
depression and other psychiatric disorders who did not take an SSRI.
There also was no evidence that maternal SSRI exposure was related to
academic performance and motor disorders in offspring.
“The
strengths of our study include the large, population based birth cohort,
prospective data on SSRI purchases during pregnancy, a comparison group
of mothers with depression who were not taking antidepressants, and an
extensive national register database that included other known
confounders,” noted Dr. Brown. “However the severity of maternal
depression cannot be ruled out as an explanation for the increased
childhood speech and language disorders among mothers who filled more
than one SSRI prescription, and further study is warranted.”
Although
Dr. Brown and colleagues were not able to confirm that the purchased
medications were taken, the association between maternal SSRI and
clinical speech and language disorders was present only among mothers
with more than one SSRI purchase during pregnancy. In addition, earlier
studies have also shown correlations between data from prescription
registries and self-reported use of antidepressants.