In Utero Antidepressant Exposure and Risks for Autism and ADHD

Deborah Cowley, MD

Maternal depression, not antidepressant use, raises risk for autism spectrum disorder in offspring, but risk for ADHD seems to stem from both factors.

Studies in rodents have linked prenatal serotonergic drug exposure to autism-like behaviors, but investigations in humans of the possible risk for autism spectrum disorder (ASD) after in utero antidepressant exposure have yielded conflicting results. Now, researchers have examined electronic data from a large healthcare system to assess risk for ASD and another neurodevelopmental disorder, attention-deficit/hyperactivity disorder (ADHD), after prenatal antidepressant exposure. Analyses controlled for maternal psychopathology. In all, 1377 children with ASD and 2243 with ADHD were matched 1:3 with unaffected children (age range, 2–19 years).

Maternal history of major depression was associated with increased risk for ASD and ADHD in offspring. Antidepressant use before or during pregnancy was associated with elevated risks for both ASD and ADHD; however, in analyses adjusted for maternal major depression, ASD risk was no longer significantly elevated but ADHD risk remained significantly elevated. Furthermore, ASD risk was not higher with use of more-serotonergic antidepressants. Risks for ASD and ADHD were lower when measures of maternal illness severity (e.g., comorbid diagnoses, number of mental health visits) were incorporated.

Citation(s):

Clements CC et al. Prenatal antidepressant exposure is associated with risk for attention-deficit hyperactivity disorder but not autism spectrum disorder in a large health system. Mol Psychiatry 2014 Aug 26; [e-pub ahead of print].