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In utero exposure to antidepressant medication and neonatal and child outcomes: a systematic review
C A Fitton1, M F C Steiner1, L Aucott1
1The Department of Child Health, Royal Aberdeen Children's Hospital, University of Aberdeen, Aberdeen, UK.
Insights
Antidepressant use during pregnancy may increase risks for preterm birth and lower gestational age in offspring. Evidence for congenital defects and neurodevelopmental issues remains inconclusive, requiring further research.
Area of Science:
- Perinatal Psychiatry
- Developmental Toxicology
- Reproductive Health
Background:
- Maternal depression is common during pregnancy.
- Antidepressant medications are frequently prescribed for pregnant individuals.
- Understanding offspring outcomes after in utero exposure is crucial.
Purpose of the Study:
- To systematically review studies on offspring outcomes following in utero exposure to antidepressants.
- To compare outcomes in offspring exposed to antidepressants versus those from untreated depressed mothers.
- To assess risks for adverse birth outcomes, congenital defects, and neurodevelopmental issues.
Main Methods:
- Comprehensive literature search across major databases (OVID, Scopus, EBSCO, Cochrane, Web of Science) from 1950 to 2018.
- Inclusion of 16 primary studies comparing antidepressant-exposed offspring with an untreated depressed comparison group.
- Systematic review methodology to synthesize findings on various offspring health endpoints.
Main Results:
- Antidepressant exposure was linked to higher risks of preterm birth and lower gestational age.
- No significant association found between antidepressant use and low birthweight or being small for gestational age.
- Conflicting evidence exists for congenital defects (particularly cardiac defects with paroxetine) and neurodevelopmental outcomes (autism, depression, behavioral scores).
Conclusions:
- Antidepressant exposure in utero is associated with adverse birth outcomes compared to untreated depression.
- Current data is insufficient to establish a causal link between antidepressants and congenital defects or developmental disorders.
- Residual confounding factors, such as depression severity, may influence findings, necessitating cautious interpretation.
Objective:
The aim of this study is to systematically review published studies, reporting outcomes to offspring following in utero exposure to antidepressant medications, which used an untreated depressed comparison group.
Methods:
OVID, Scopus, EBSCO Collections, the Cochrane Library and Web of Science databases were searched for relevant publications published between January 1950 and May 2018 and a total of 188 potentially eligible studies were identified.
Results:
Following review, 16 primary studies were eligible for inclusion. Antidepressant exposure was associated with an increased risk of lower gestational age, preterm birth, but not low birthweight or being small for gestational age compared to untreated depression. There is some evidence that congenital defects are associated with antidepressant use, particularly between cardiac defects and paroxetine use. There is conflicting evidence regarding neurodevelopment in offspring, with some reports of increased incidence of autistic spectrum disorders and depression, but also reports of no problems when measuring emotional symptoms, peer problems, conduct problems and hyperactivity-inattention scores.
Conclusion:
When compared with an untreated depressed group, antidepressant exposure was associated with adverse outcomes at birth, while there is insufficient data to determine whether the association between antidepressants and congenital defects or developmental disorders is a true association. However, although we compared treated vs. untreated depression there still may be residual confounding as an untreated depressed group is likely to have less severe depression.
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