Monday, October 17, 2016

Study Suggests Association Between SSRIs in Pregnancy, Speech Disorders in Offspring

A study published last week in JAMA Psychiatry suggests that children born to women who took selective serotonin reuptake inhibitors (SSRIs) during pregnancy may be at an elevated risk of speech and language disorders. While experts say the study raises important questions, more research is needed to determine whether exposure to SSRIs confers greater risk than untreated depression during pregnancy over the long term.

For the study, Alan S. Brown, M.D., M.P.H., director of the Unit in Birth Cohort Studies at the New York State Psychiatric Institute, tracked the incidence of speech/language, scholastic, and motor disorders from birth to 14 years in 56,000 children born in Finland between 1996 and 2010. 

The offspring were divided into three groups: 15,596 were in the SSRI-exposed group (mothers diagnosed as having depression-related psychiatric disorders with a history of purchasing SSRIs during pregnancy); 9,537 were in the unmedicated group (mothers diagnosed as having depression-related psychiatric disorders without a history of purchasing SSRIs during pregnancy); and 31,207 were in the unexposed group (mothers without a psychiatric diagnosis or a history of purchasing SSRIs). 

Over the study period, there was a total of 829, 187, and 285 instances of speech/language, scholastic, and motor disorders, respectively. The authors found that children in the SSRI-exposed group and the unmedicated group were at a significantly increased risk of speech/language disorders compared with those in the unexposed group.

Additional analysis revealed that children of mothers who purchased SSRIs at least twice during pregnancy had a 37% increased risk of speech/language disorders compared with offspring in the unmedicated group and a 63% increased risk compared with children in the unexposed group. There were no significant differences in the risk of the other disorders between offspring in the SSRI-exposed group and the unmedicated group.

“Overall the study is reassuring because there were no scholastic or motor associations, and the risk of language delay, if real, is very small,” Jennifer Payne, M.D., the director of the Women's Mood Disorders Center at Johns Hopkins School of Medicine, told Psychiatric News.

However, Payne noted that because the study did not control for severity of depression or postpartum depression, there is no way of knowing whether antidepressant exposure is actually associated with speech and language delays.

“Postpartum depression has long been known to affect language development and IQ in children,” she added.

“Brown et al have identified a very important research question, … but the current report does not answer whether exposure to SSRIs or untreated depression during pregnancy are in equipoise with respect to neurodevelopmental toxicity or if, over the long-term, one confers greater risk,” Lee Cohen, M.D., and Ruta Nonacs, M.D., Ph.D., of Massachusetts General Hospital wrote in a related editorial.

“Given the extent to which depression during pregnancy predicts risk for postpartum depression with its attendant morbidity, and in light of the robust data describing the adverse effects of maternal psychiatric morbidity on long-term child development, clinicians will need to broaden the conceptual framework used to evaluate relative risk of SSRI use during pregnancy as they navigate this clinical arena with patients making individual decisions to match patient wishes,” Cohen and Nonacs concluded.

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