Antidepressant Use in Pregnancy and the Risk of Attention Deficit with or without Hyperactivity Disorder in Children
Takoua Boukhris1,2, Odile Sheehy2, Anick Bérard1,2
1Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.
Insights
Antidepressant use in late pregnancy, particularly tricyclics, may increase a child's risk for attention deficit hyperactivity disorder (ADHD). This risk appears independent of maternal mental health conditions.
Area of Science:
- Perinatal Psychiatry
- Child Neurology
- Pharmacoepidemiology
Background:
- The link between prenatal antidepressant (AD) exposure and childhood attention deficit hyperactivity disorder (ADHD) remains controversial.
- Existing research presents conflicting findings regarding this association.
Purpose of the Study:
- To investigate the association between antidepressant use during pregnancy and the risk of ADHD in offspring.
- To examine ADHD risk related to overall and specific classes of antidepressants used in utero.
Main Methods:
- A register-based cohort study utilized the Quebec Pregnancy/Children Cohort (QPC).
- Included 144,406 singleton, full-term, live-born infants from 1998-2009.
- Cox proportional hazards regression models assessed adjusted hazard ratios (HR) and 95% confidence intervals (CI).
Main Results:
- Over 542,897 person-years, 4,564 (3.2%) infants were diagnosed with ADHD.
- Maternal AD use in the 2nd or 3rd trimester was linked to a 1.3-fold increased ADHD risk (HR 1.3, 95% CI 1.0-1.6).
- Tricyclic antidepressant use showed a significant association with increased ADHD risk (HR 1.8, 95% CI 1.0-3.1), while SSRIs and SNRIs did not.
Conclusions:
- Antidepressant use in the 2nd and 3rd trimesters, specifically tricyclics, may be an independent risk factor for childhood ADHD.
- This association persists beyond the risk attributed to maternal depression, anxiety, or ADHD.
- Residual confounding due to indication severity cannot be entirely excluded.
Background:
The association between antidepressant (AD) use during pregnancy and the risk of attention deficit with or without hyperactivity disorder (ADHD) in children is debated. We investigated the risk of ADHD associated with overall and class-specific antidepressant exposure in utero.
Methods:
We designed a register-based cohort study using the Quebec Pregnancy/Children Cohort (QPC). A total of 144 406 singleton full-term live-born from 1998 to 2009 were included. Cox proportional hazards regression models were used to estimate unadjusted and adjusted hazard ratio with 95% confidence interval (CI).
Results:
During 542 897 person-years of follow-up, 4564 (3.2%) infants were identified with ADHD. The mean age at first ADHD diagnosis was 6.3 ± 2.3 years (range 0-11 years), and the mean age at first ADHD medication use was 7.0 ± 1.5 years. Adjusting for potential confounders, including maternal history of depression/anxiety and ADHD, AD use during the 2nd or 3rd trimester of pregnancy was associated with an increased risk of (HR 1.3, 95% CI 1.0, 1.6; 134 exposed cases). More specifically, tricyclic use was associated with an increased risk of ADHD (HR 1.8, 95% CI 1.0, 3.1; 16 exposed cases); SSRI and SNRI use were not associated with increased ADHD risk.
Conclusion:
This study suggests that AD use during the 2nd and 3rd trimester of pregnancy, specifically tricyclics, is an independent risk factor for ADHD in children above and beyond the risk associated with maternal depression/anxiety or ADHD. However, residual confounding by indication severity could not be completely ruled out.
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