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Original Investigation
July 12, 2017

Association of Antidepressant Medication Use During Pregnancy With Intellectual Disability in Offspring

Author Affiliations
  • 1Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
  • 2The Seaver Autism Center for Research and Treatment, Mount Sinai, New York, New York
  • 3Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  • 4Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
  • 5Department of Community Mental Health, University of Haifa, Haifa, Israel
JAMA Psychiatry. Published online July 12, 2017. doi:10.1001/jamapsychiatry.2017.1727
Key Points

Question  Does maternal antidepressant medication use during pregnancy increase the risk of intellectual disability in offspring?

Findings  In this population-based cohort study of 179 007 pregnancies, an association of maternal antidepressant medication use during pregnancy with intellectual disability in offspring was attenuated when parental factors other than medication use were taken into account.

Meaning  An elevated risk of intellectual disability in children born to women who used antidepressant medication during pregnancy is likely attributable to factors underlying the treatment and not to the antidepressant medication itself.

Abstract

Importance  Maternal antidepressant medication use during pregnancy has previously been associated with adverse outcomes in offspring, but to our knowledge, the association with intellectual disability (ID) has not been investigated.

Objectives  To examine the association of maternal antidepressant medication use during pregnancy with ID in offspring and investigate the importance of parental mental illness for such an association.

Design, Setting, and Participants  A population-based cohort study of 179 007 children born from January 1, 2006, through December 31, 2007, with complete parental information from national registers who were followed up from birth throughout 2014.

Main Outcomes and Measures  We estimated relative risks (RRs) and 95% CIs of ID in children exposed during pregnancy to any antidepressant medication or specifically to selective serotonin reuptake inhibitor (SSRI) antidepressants, all other non-SSRI antidepressants, or other nonantidepressant psychotropic medications. Analyses were adjusted for potential confounders. In addition to full population analyses, we used a subsample to compare mothers who used antidepressants during pregnancy with mothers who had at least one diagnosis of depression or anxiety before childbirth but did not use antidepressants during pregnancy.

Results  Of the 179 007 children included in the study (mean [SD] age at end of follow-up, 7.9 [0.6] years; 92 133 [51.5%] male and 86 874 [48.5%] female), ID was diagnosed in 37 children (0.9%) exposed to antidepressants and in 819 children (0.5%) unexposed to antidepressants. With adjustment for potential confounders, the RR of ID after antidepressant exposure was estimated at 1.33 (95% CI, 0.90-1.98) in the full population sample and 1.64 (95% CI, 0.95-2.83) in the subsample of women with depression. Results from analyses of SSRI antidepressants, non-SSRI antidepressants, and nonantidepressant psychotropic medications and analyses in the clinically relevant subsample did not deviate from the full-sample results.

Conclusions and Relevance  The unadjusted RR of ID was increased in offspring born to mothers treated with antidepressants during pregnancy. After adjustment for confounding factors, however, the current study did not find evidence of an association between ID and maternal antidepressant medication use during pregnancy. Instead, the association may be attributable to a mechanism integral to other factors, such as parental age and mother’s psychiatric disorder.

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