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Prenatal antidepressant use and risk of attention-deficit/hyperactivity disorder in offspring: population based
Kenneth K C Man1,2,3,4, Esther W Chan1, Patrick Ip2
1Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Insights
Prenatal antidepressant use may be linked to a higher risk of attention-deficit/hyperactivity disorder (ADHD) in children. However, this association may be partly explained by maternal psychiatric conditions, suggesting a smaller causal effect than previously thought.
Area of Science:
- Neuroscience
- Psychiatry
- Public Health
Background:
- Maternal antidepressant use during pregnancy is a growing concern.
- The potential impact on offspring neurodevelopment, specifically attention-deficit/hyperactivity disorder (ADHD), requires thorough investigation.
Purpose of the Study:
- To evaluate the association between prenatal antidepressant exposure and the risk of ADHD in offspring.
- To differentiate between a direct causal link and confounding factors like maternal psychiatric disorders.
Main Methods:
- A population-based cohort study utilizing Hong Kong electronic medical records.
- Involved over 190,000 children born between 2001-2009, followed until 2015.
- Hazard ratios were calculated, adjusting for maternal psychiatric history and other drug use. Sensitivity and sibling-matched analyses were performed.
Main Results:
- Children exposed to antidepressants prenatally showed an increased risk of ADHD (adjusted hazard ratio: 1.39).
- Maternal psychiatric disorders independently increased ADHD risk in offspring (hazard ratio: 1.84).
- Sibling-matched analysis found no significant difference in ADHD risk between exposed and unexposed siblings.
Conclusions:
- The observed association between prenatal antidepressant use and offspring ADHD risk is likely influenced by confounding by indication.
- The true causal effect of prenatal antidepressants on ADHD risk may be smaller than previously estimated.
- Further research is needed to clarify the nuanced relationship, considering maternal health and medication use.
Abstract:
Objective To assess the potential association between prenatal use of antidepressants and the risk of attention-deficit/hyperactivity disorder (ADHD) in offspring.Design Population based cohort study.Setting Data from the Hong Kong population based electronic medical records on the Clinical Data Analysis and Reporting System.Participants 190 618 children born in Hong Kong public hospitals between January 2001 and December 2009 and followed-up to December 2015.Main outcome measure Hazard ratio of maternal antidepressant use during pregnancy and ADHD in children aged 6 to 14 years, with an average follow-up time of 9.3 years (range 7.4-11.0 years).Results Among 190 618 children, 1252 had a mother who used prenatal antidepressants. 5659 children (3.0%) were given a diagnosis of ADHD or received treatment for ADHD. The crude hazard ratio of maternal antidepressant use during pregnancy was 2.26 (P<0.01) compared with non-use. After adjustment for potential confounding factors, including maternal psychiatric disorders and use of other psychiatric drugs, the adjusted hazard ratio was reduced to 1.39 (95% confidence interval 1.07 to 1.82, P=0.01). Likewise, similar results were observed when comparing children of mothers who had used antidepressants before pregnancy with those who were never users (1.76, 1.36 to 2.30, P<0.01). The risk of ADHD in the children of mothers with psychiatric disorders was higher compared with the children of mothers without psychiatric disorders even if the mothers had never used antidepressants (1.84, 1.54 to 2.18, P<0.01). All sensitivity analyses yielded similar results. Sibling matched analysis identified no significant difference in risk of ADHD in siblings exposed to antidepressants during gestation and those not exposed during gestation (0.54, 0.17 to 1.74, P=0.30).Conclusions The findings suggest that the association between prenatal use of antidepressants and risk of ADHD in offspring can be partially explained by confounding by indication of antidepressants. If there is a causal association, the size of the effect is probably smaller than that reported previously.
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