Prenatal Antidepressant Exposure and Risk of Depression and Anxiety Disorders: An Electronic Health Records-Based...

To examine the associations of serotonergic antidepressant exposure during pregnancy with the risk of depression and anxiety disorders in offspring.

The Mayo Clinic Rochester Epidemiology Project medical records-linkage system was used to study offspring born to mothers who were prescribed a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor (S/NRI users, n = 837) during pregnancy (1997-2010). Cox regression models were used to calculate hazard ratios to examine associations of S/NRIs with diagnosed depression and anxiety, defined based on a review of medical records by 2 board-certified psychiatrists, vs no maternal antidepressant use during pregnancy (nonusers, n = 863) and maternal antidepressant use in the year prior to pregnancy (former users, n = 399) as control groups.

After all adjustments for covariates, children born to S/NRI users during pregnancy did not differ in onset of depression or anxiety from the children of nonusers (adjusted hazard ratio = 1.00, 95% CI [0.74, 1.85]) or former users (adjusted hazard ratio = 0.94, 95% CI [0.69, 1.27]). These associations were similar when exposure was limited only to selective serotonin reuptake inhibitors.

The results suggest that higher rates of childhood and adolescent depression or anxiety conditioned on maternal S/NRI use in pregnancy are more likely to be driven by maternal depression or underlying propensity for depression rather than direct pharmacological effects of in utero S/NRI exposure.

The authors examined the association between exposure to serotonergic antidepressants during pregnancy and risk of having depression and anxiety in their offspring using data regarding 2,099 participants in the Mayo Clinic Rochester Epidemiology Project. After accounting for maternal depression, prenatal serotonergic antidepressant exposure was not associated with higher risk for these outcomes compared to either unexposed children or those whose mothers used antidepressants prior to but not during pregnancy. Findings suggest that increased depression and anxiety observed in prenatally exposed children is more likely to be driven by maternal depression or underlying factors rather than the direct effects of pharmacological exposure to serotonin-based antidepressant medication.