FROM JAMA PSYCHIATRY

Selective serotonin reuptake inhibitors taken during pregnancy are linked to a 37% increased risk of speech and language disorders in the children prenatally exposed to them, according to a prospective birth cohort study.

That risk occurs when children exposed prenatally are compared with children whose mothers did not take SSRIs but who had a diagnosis for which the antidepressants are indicated.

“The finding was observed only in offspring of mothers who purchased at least two SSRI prescriptions during pregnancy,” reported Alan S. Brown, MD, of New York State Psychiatric Institute in New York City, and his associates (JAMA Psychiatry. 2016 Oct 12. doi: 10.1001/jamapsychiatry.2016.2594 ). “This finding is particularly noteworthy because these women were more likely to have taken these medications and were exposed for a longer period and to larger amounts of SSRIs during pregnancy, compared with women who filled only one prescription.”

From among an initial cohort of 845,345 pregnant women in Finland, the researchers followed a final cohort of 56,340 offspring. Most of the children (86.6%) were 9 years old or younger at the end of study follow-up, running from 1996 to 2010, and the oldest children were aged 14 years. The researchers used Finland’s national registries to determine the children’s and mothers’ diagnoses and the mothers’ history of prescriptions from 30 days before pregnancy through delivery.

Among all children, 15,596 children were born to women who took SSRIs for depression or another SSRI-indicated psychiatric condition, and 31,207 children were born to mothers who had neither a psychiatric diagnosis nor a history of taking SSRIs during pregnancy. The remaining 9,537 children had mothers with a psychiatric diagnosis but who did not take SSRIs during pregnancy.

The average ages of the children at diagnosis were 4.4 years for speech or language disorders, 3.6 years for scholastic problems, and 7.7 years for motor disorders. When the researchers compared the children prenatally exposed to SSRIs to the children of mothers with a depression-related diagnosis but not taking SSRIs during pregnancy, the rates of scholastic or motor disorders did not differ.

For language and speech disorders, however, children whose mothers purchased two SSRI prescriptions had a 37% increased risk of a disorder, compared with children whose mothers had a diagnosis but did not purchase SSRIs. Without the requirement of at least two prescriptions, the statistical difference did not exist.

That increased risk occurred after adjustment for sex, mother’s parity, marital status, socioeconomic status, place of residence, both parents’ ages, the children’s gestational age at birth, prenatal exposure to antiepileptic drugs, exposure to anxiolytics/sedatives, history of chronic diseases, death of the child’s parent, mother’s country of birth, maternal smoking or substance abuse, and the psychiatric history of both parents. Data on maternal alcohol consumption were unavailable. Both the children exposed to SSRIs and the children of unmedicated mothers with a psychiatric condition had a higher risk of speech and language disorders.

The research was funded by the National Institutes of Health; the Sackler Foundation of Columbia University, New York; and the University of Turku (Finland). One of the researchers, David Gyllenberg, MD, reported receiving research funding from the Sigrid Juselius Foundation, the Foundation for Pediatric Research in Finland, and the Finnish Medical Foundation. No other conflicts of interest were disclosed.

cpnews@frontlinemedcom.com

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