Pregnancy, Antidepressants and Autism: What’s the Risk?
A new study in JAMA Pediatrics found an association between antidepressant use in mothers during pregnancy and the incidence of autism in children. UR Medicine high-risk pregnancy expert Dr. Neil Seligman sorts through this issue, offering advice for women who suffer from depression and are pregnant or want to become pregnant.
Depression and antidepressant use during pregnancy is exceedingly common and the safety debate surrounding this issue is often the topic of many medical studies and news reports. Like any medical concern, the best approach is to talk with your provider. But, in general, there are some facts that may help guide you.
The drugs most typically prescribed for depression are in a category known as Selective Serotonin Reuptake Inhibitors, or SSRIs. The decision whether or not to continue taking an SSRI during pregnancy should be based on a woman’s need. If she was already on course to end the treatment—even if she wasn’t pregnant or planning a pregnancy—she can stop as planned. But if she still needs the medication to treat her depression, she should continue taking it. Counseling is also effective in treating depression and worth considering either in place of, or in addition to medication, if it’s available to her.
It’s important to note that the association found in this study was small, and that the vast majority of mothers taking SSRIs do not have children with autism. (Specifically, just over 1 percent of the women on SSRIs in this study had children with autism. Those who were not on SSRIs had children with autism slightly less than 1 percent of the time.) Additionally, an association is not the same as cause and effect. The difference between the two groups of women could have been due to other lifestyle issues that the study could not account for.
While this study adds significantly to our knowledge of the safety of SSRIs during pregnancy, it is not without limitations. For example, the study was based on prescriptions that were filled and not whether the medications were actually taken. Furthermore, several other large, well-done studies have found no such association between SSRIs and autism.
Beyond Autism Spectrum Disorder, there is no evidence that links SSRIs to birth defects, with the possible exception of Paxil (paroxetine). And if Paxil is the most effective option for her, a woman should be encouraged to continue it as needed during pregnancy. While some signs like jitteriness or a weak cry may be seen in some newborns whose mothers used SSRIs during pregnancy, they are harmless and short-lived.
Another recent study pointed to a link between antidepressants taken in late pregnancy and a higher risk for a newborn to have a potentially life-threatening breathing problem known as persistent pulmonary hypertension (PPHN). It’s important to look at this in light of the risk of PPHN in all newborns. In this study, the risk of PPHN in newborns was 0.34 percent for those born to women who took SSRIs, and 0.25 percent in newborns of women who didn’t. That means there is approximately 1 extra case of PPHN for every 1,000 women using SSRIs. If we judge these risks as unacceptable, it’s as if we are denying the fact that the consequences of untreated depression are more common and potentially more serious.
Medication use during pregnancy is a complicated issue. Women and their providers should consider the reproductive safety of any drug before it’s prescribed. They might also consider a pre-conception consultation with a high-risk pregnancy specialist, to discuss medication risks and help them decide whether the best approach is to continue or change a medication, or if it should be stopped altogether.
However, many pregnancies are unplanned. When a woman learns she’s pregnant, she should talk with a health provider right away, before stopping any medications. Stopping medications when a woman is already pregnant does not always remove the risk. For example, stopping a medication in the second trimester has essentially no benefit in preventing birth defects. The type of drug, the dose, and how and when it’s taken are all important considerations during pregnancy.
New information prompted this update of a post from June 2015.
Neil S. Seligman, M.D., is an assistant professor of Obstetrics and Gynecology in the Division of Maternal Fetal Medicine. He specializes in high-risk pregnancy care at UR Medicine’s Strong Memorial Hospital.
Lori Barrette |