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Original Investigation
November 2016

Association of Selective Serotonin Reuptake Inhibitor Exposure During Pregnancy With Speech, Scholastic, and Motor Disorders in Offspring

Author Affiliations
  • 1Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
  • 2Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
  • 3Division of Epidemiology, New York State Psychiatric Institute, New York
  • 4Sackler Institute for Developmental Psychobiology, Columbia University College of Physicians and Surgeons, New York, New York
  • 5New York State Psychiatric Institute, New York
  • 6Department of Child Psychiatry, University of Turku, Turku, Finland
  • 7Teratology Information Service, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  • 8Department of Clinical Pharmacology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  • 9Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
  • 10Department of Child Psychiatry, Turku University Central Hospital, Turku, Finland
  • 11Helsinki University, Helsinki, Finland
  • 12National Institute for Health and Welfare, Helsinki, Finland
JAMA Psychiatry. 2016;73(11):1163-1170. doi:10.1001/jamapsychiatry.2016.2594
Key Points

Question  Is exposure to selective serotonin reuptake inhibitors during pregnancy associated with an increased risk of adverse speech, scholastic, or motor outcomes in offspring?

Findings  In this cohort study, offspring of mothers who purchased at least 2 selective serotonin reuptake inhibitors prescriptions during pregnancy had a significantly increased risk of speech/language disorders compared with offspring of mothers diagnosed as having psychiatric disorders who did not take medication during pregnancy.

Meaning  The findings suggest that use of selective serotonin reuptake inhibitors during pregnancy increases the risk of speech/language disorders in offspring.

Abstract

Importance  Speech/language, scholastic, and motor disorders are common in children. It is unknown whether exposure to selective serotonin reuptake inhibitors (SSRIs) during pregnancy influences susceptibility to these disorders.

Objective  To examine whether SSRI exposure during pregnancy is associated with speech/language, scholastic, and motor disorders in offspring up to early adolescence.

Design, Setting, and Participants  This prospective birth cohort study examined national population-based register data in Finland from 1996 to 2010. The sampling frame includes 845 345 pregnant women and their singleton offspring with data on maternal use of antidepressants and depression-related psychiatric disorders during pregnancy.

Exposures  There were 3 groups of offspring: 15 596 were in the SSRI-exposed group, ie, had mothers diagnosed as having depression-related psychiatric disorders with a history of purchasing SSRIs during pregnancy; 9537 were in the unmedicated group, ie, had mothers diagnosed as having depression-related psychiatric disorders without a history of purchasing SSRIs during pregnancy; and 31 207 were in the unexposed group, ie, had mothers without a psychiatric diagnosis or a history of purchasing SSRIs.

Main Outcomes and Measures  Cumulative incidence of speech/language, scholastic, or motor disorders (829, 187, and 285 instances, respectively) from birth to 14 years. All hypotheses tested were formulated before data collection.

Results  Of the 56 340 infants included in the final cohort, 28 684 (50.9%) were male and 48 782 (86.6%) were 9 years or younger. The mean (SD) ages of children at diagnosis were 4.43 (1.67), 3.55 (2.67), and 7.73 (2.38) for speech/language, scholastic, and motor disorders, respectively. Offspring of mothers who purchased SSRIs at least twice during pregnancy had a significant 37% increased risk of speech/language disorders compared with offspring in the unmedicated group. The cumulative hazard of speech/language disorders was 0.0087 in the SSRI-exposed group vs 0.0061 in the unmedicated group (hazard ratio, 1.37; 95% CI, 1.11-1.70; P = .004). There was a significantly increased risk of these disorders in offspring in the SSRI-exposed and unmedicated groups compared with offspring in the unexposed group. For scholastic and motor disorders, there were no differences between offspring in the SSRI-exposed group and in the unmedicated group.

Conclusions and Relevance  Exposure to SSRIs during pregnancy was associated with an increased risk of speech/language disorders. This finding may have implications for understanding associations between SSRIs and child development.

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