Effects of Selective Serotonin Reuptake Inhibitor Exposure During Pregnancy

Shirin Zadeh, Mercer University College of Pharmacy

Psychotropic medication exposure has been shown to alter neural plasticity and shift sensitive periods in perceptual development.1  Selective serotonin reuptake inhibitors (SSRIs) are antidepressive agents indicated for mood disorders that can also cross the placenta and enter the fetal circulation.2  The maternal depressed mood and long-term use of SSRIs during pregnancy have been discovered to impact infants’ behavior.  It was not indicated whether exposure to selective serotonin reuptake inhibitors (SSRIs) during pregnancy influences susceptibility to speech, language and motor disorders.3

 

Association of Selective Serotonin Reuptake Inhibitor Exposure During Pregnancy with Speech, Scholastic, and Motor Disorders in Offspring4

Design Population-based, prospective, cohort study; N= 56,340
Objective To examine whether SSRI exposure during pregnancy is associated with speech/language, scholastic, and motor disorders
Study Groups SSRI-exposed (n= 15,596); unmedicated (n= 9,537); unexposed (n= 31,207)
Methods Pregnant women with depression and depression-related psychiatric disorders using antidepressant agents were included. The national registry included data on maternal demographic information, diagnoses during pregnancy and delivery, and neonatal outcomes. The group exposed to SSRIs and the comparison groups were obtained from the drug reimbursement register. Participants were categorized into 3 groups: the SSRI-exposed group who were offspring of mothers diagnosed with depression or another psychiatric disorder who made purchases of SSRIs by prescription between 30 days before pregnancy and delivery; the unmedicated group with mothers diagnosed as having depression associated with SSRI use with no history of SSRI purchase during pregnancy; and the unexposed group with mothers without a psychiatric diagnosis associated without SSRI use or a history of purchasing antidepressants or antipsychotics any time prior to or during pregnancy.
Duration 1996 to 2010
Primary Outcome Measure Cumulative incidence of speech/language, scholastic, or motor disorders from birth to 14 years
Baseline Characteristics SSRI-exposed Unmedicated Unexposed
Male offspring, n (%) 7,874 (50.5) 4,818 (50.5) 992 (51.2)
Maternal age years, n (%)
≤19 520 (3.3) 943 (9.9) 769 (2.5)
20-29 7,364 (47.2 4,484 (47.0) 15,428 (49.4)
30-39 6,964 (44.7) 3,719 (39.0) 13,886 (44.5)
≥40 748 (4.8) 391 (4.1) 1,124 (3.6)
Exposure to drugs, n (%)
Teratogenic 17 (0.1) 9 (0.1) 30 (0.1)
Anxiolytics/sedative 2,892 (18.5) 421 (4.4) 147 (0.5)
Antiepileptic 491 (3.2) 159 (1.7) 135 (0.4)
Results SSRI-exposed versus unmedicated SSRI-exposed versus unexposed Unmedicated versus unexposed
Hazard ratio (HR) p-value HR p-value HR p-value
Speech/language disorder 1.09 0.37 1.58 <0.001 1.45 <0.001
Scholastic disorder 0.97 0.88 1.89 <0.001 1.28 0.02
Motor disorder 1.37 0.06 0.06 <0.001 0.18 0.73
Adverse Events Common Adverse Events: N/A
Serious Adverse Events: N/A
Percentage that Discontinued due to Adverse Events: N/A
Study Author Conclusions Exposure to SSRIs during pregnancy was associated with an increased risk of speech/language disorders. This finding may have implications for understanding associations between SSRIs and child development.

 

Although a comparison group of mothers diagnosed with depression not treated with antidepressants was included, the severity of maternal depression cannot be ruled out as an explanation for the increased childhood speech and language disorders. Moreover, it is possible that increased care-seeking in mothers treated with SSRIs may have accounted for the greater ascertainment of the observed conditions in this group compared with those with no SSRI use. In addition, since this study was based on population registries, it was not possible to confirm that the purchased medications were taken. Nevertheless, the association between maternal SSRI purchase and clinical speech and language disorders was present among mothers with SSRI purchase during pregnancy. According to the findings of this study, maternal SSRI use should be considered as a potential risk factor for childhood speech and language outcomes.

 

References

  1. Weikum WM, Oberlander TF, Hensch TK, Werker JF. Prenatal exposure to antidepressants and maternal depressed mood alter trajectory of infant speech perception. Proc Natl Acad Sci USA. 2012;109 Suppl 2:17221-7.
  2. Rampono J, Simmer K, Ilett KF, et al. Placental transfer of SSRI and SNRI antidepressants and effects on the neonate. Pharmacopsychiatry. 2009;42(3):95-100.
  3. Yonkers KA, Wisner KL, Stewart DE, et al. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Obstet Gynecol.2009;114:703–713.
  4. Brown AS, Gyllenberg D, Malm H, et al. Association of Selective Serotonin Reuptake Inhibitor Exposure During Pregnancy with Speech, Scholastic, and Motor Disorders in Offspring. JAMA Psychiatry. 2016.
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