Healthcast : A Study on Antidepressant Use During Early Pregnancy

Risk assessment The risk of autism associated with antidepressants if it exists

The choice to take antidepressant medication during pregnancy can be hard.

In contrast, a study in the New England Journal of Medicine found the opposite to be true: antidepressant use during pregnancy is not associated with an increased risk of autism.

Perry Wilson, MD, a MedPage Today physician reviewer and Yale nephrologist, who wasn't involved in the study, said in an exclusive interview that taken together, the results of the three studies do suggest a slightly higher risk of autism in children born to mothers who were taking antidepressants - but the greater the control for confounders, the more tenuous the relationship becomes, and it's not clear if the antidepressants are the cause of the condition.

- In the study with Ontario data, no association was found between children with ASD and the use of SSRI antidepressants during pregnancy among mothers receiving public drug coverage.

She told the Business Standard: 'The findings from this review suggest that antidepressant treatment may be a "marker" of women who may have an elevated risk of giving birth to a child with ASD.

"The ability to compare siblings who were differentially exposed to antidepressants in pregnancy is a major strength of this study", said study leader Brian D'Onofrio, in a statement.

Although many cases are minor, an estimated 20,000 pregnant women each year are thought to take antidepressants - around one in 25 of all British pregnancies. They also took into consideration the antidepressant prescription among the adults in the nation, along with autism and ADHD diagnosis in children.

The large scale study appears to rule out a connection between women who take antidepressants in the early stages of pregnancy and whether the child is at increased risk of autism or ADHD.

The researchers followed up with the families through 2013 and found there was no increased risk of autism or ADHD.

Irene Petersen, a researcher at the University College London, who was not involved in the study, said it's tricky to study the exposure on antidepressants in pregnancy and the risk of ASDs, as the effects of drug treatment are often hard to be separated from other risk factors such as maternal illnesses.

'However, I would be very cautious about reaching a conclusion that antidepressants treatment in pregnancy itself is causing autism. A better understanding of these other factors could help clarify what role, if any, antidepressants during pregnancy actually play in autism. In other words, reporting the results for each trimester individually means their study would've had less significant numbers when it came to SSRIs during pregnancy and autism risk. While some women may prefer not to take medications it's important to know that leaving depression untreated can have a negative impact on you and on your baby's health.

In the sibling matchup, the children had essentially the same risk for autism, ADHD and poor fetal growth whether they were exposed to antidepressants in the womb or not.

Writing in JAMA Pediatrics, the team of scientists said up to 15 per cent of women have depression during pregnancy.

D'Onofrio added that the decision to stay on medication is a personal one and should always be made with the consultation of their doctor. "But that association goes completely away when you compare siblings". She studied more than 35,000 births and also compared rates of autism among brothers and sisters whose mothers used antidepressants during some pregnancies but not others.

For example, a genetic overlap exists in people who have depression and people who have autism. Maternal depression and autism also may be related genetically, they added.

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