SSRIs in Late Pregnancy Linked to Increased Risk for Anxious, Depressed Behaviors at Age 5

Children whose mothers took selective serotonin reuptake inhibitors (SSRIs) during the last trimester of pregnancy may be more likely to experience anxious and depressed symptoms by age 5 years compared with children who were not exposed to the medications, according to a report in the Journal of the American Academy of Child and Adolescent Psychiatry. However, the study found no evidence for such an effect following SSRI exposure earlier than 29 weeks, and no effect on externalizing, social, and emotional problems.

“It is reassuring that prenatal SSRI did not confer a substantial increased risk for greater externalizing behaviors in preschool-age children or for more problematic temperament in terms of emotionality, sociability, activity, or shyness, and this was consistently evident across the various exposure windows,” Angela Lupattelli, Ph.D., of the University of Oslo, Norway, and colleagues wrote. 

Lupattelli and colleagues examined data from the Norwegian Mother and Child Cohort Study, a prospective population-based pregnancy cohort study conducted by the Norwegian Institute of Public Health. The analysis included data on 7,944 women who reported having depressive/anxiety disorders before and/or during pregnancy and 8,359 pregnancy-child dyads. A total of 605 women took SSRIs at some point during pregnancy. The outcomes of children born to women who took SSRIs in early (0-16 weeks), mid- (weeks 17-28), or late pregnancy (week 29 or later) were compared with those of children who were not exposed to medication.

Mothers were asked to assess their child’s development at ages 1.5, 3, and 5 years using the Child Behavior Checklist for preschool children and the short form of the Emotionality, Activity, and Shyness Temperament Questionnaire.

The results showed for each year increase in age, children exposed to SSRIs late in gestation had an increased risk of anxious or depressed behaviors compared with unexposed children, reaching statistical significance at age 5.

There was no such association with other developmental outcomes or with any developmental outcome following mid- or early-pregnancy SSRI exposure. Moreover, there appears to be a protective effect of SSRI exposure against attention problems, though it diminishes as the child ages, according to the report. 

“Our findings, coupled with those in animal models, may point to a plausible late-pregnancy fetal vulnerability to SSRI and/or susceptibility to serotonin disruption,” Lupattelli and colleagues wrote. “This association has to be confirmed or refuted by future research, but at present may provide some insights into potentially important periods of fetal vulnerability to SSRI exposure. This potential risk needs to be balanced against a potential detrimental effect of untreated maternal depression. …[T]his information may assist clinicians when evaluating the risk of treatment with SSRI at specific timing during gestation.”

For further information, see the Psychiatric News article “Study Reports on Risks, Benefits of SSRIs Taken During Pregnancy.”

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