Involving more than 1.5 million Swedish offspring born between 1996 and 2012, the study—published in the Journal of the American Medical Association—found that while first-trimester antidepressant exposure was significantly associated with preterm birth, it was not associated with a risk of a baby being born small for gestational age or later developing autism spectrum disorder or attention-deficit/hyperactivity disorder. (Here are signs your child could be on the autism spectrum.)
“This is a nicely designed study,” says Shilpi Mehta-Lee, MD, assistant professor in the Department of Obstetrics and Gynecology at NYU Langone Medical Center. She points out that, to isolate the impact of antidepressants on children exposed in utero, the researchers compared siblings in families where the mother used antidepressants in one pregnancy but not the other. “The results show that exposed and unexposed siblings had essentially the same risk for developing autism, ADHD or poor fetal growth,” explains Dr. Mehta-Lee. “With over 1.5 million infants, the study comprises one of the largest and most comprehensive populations ever analyzed to understand the impact of antidepressant use during pregnancy.”
The findings can put mothers-to-be at ease about the risk of autism and ADHD, but antidepressants have also been linked some birth defects. Relax, says Dr. Mehta-Lee: Most studies suggest almost no increase in congenital defects when the mother was taking common antidepressants in the class known as selective serotonin reuptake inhibitors (SSRI), and animal studies support these findings. Any connections between the drugs and pregnancy complications have been based on observational studies, says Dr. Mehta-Lee: “The results should be interpreted with caution due to methodological limitations—for example, lack of control for use of tobacco, alcohol, or illicit substances,” she explains. “Many studies suggest that first trimester exposure to SSRIs does not increase rates of stillbirth, or low birth weight.”
Generally, SSRIs are approved for use during pregnancy, says Dr. Mehta-Lee, with the exception of paroxetine (Paxil), which has been associated with an increase in congenital heart defects (although those findings have not been consistent). She says the majority of safety data in pregnancy is on fluoxetine (Prozac), and sertraline (Zoloft); however, any antidepressant should be given under the supervision of a psychiatric care provider as well as an obstetric or maternal/fetal-medicine specialist familiar with the use of these and additional agents in pregnancy. “Other agents can be used safely, but thorough counseling is recommended ideally pre-conception or at least early in pregnancy if possible.”
The most important thing is to be open with your physician about mental health issues, and ask questions about antidepressants and pregnancy. “I think simply asking what risks the physician sees to her and her fetus, as well as the risks of discontinuing drugs is worthwhile and a good starting point for this dialogue,” says Dr. Mehta-Lee.