Taking antidepressants during pregnancy does not increase the risk of children going on to develop autism or attention deficit hyperactivity disorder (ADHD), according to an analysis of more than half a million pregnancies.
The study, conducted by researchers at the University of Hong Kong and published in the Lancet Psychiatry, analysed data from 37 existing studies that included 600,000 pregnant women who had taken antidepressants, and 25 million women who had no antidepressant use during their pregnancies.
Before controlling for key factors such as pre-existing mental health conditions, the analysis found that antidepressant use by the mother during pregnancy was associated with a 35% increased risk of ADHD and a 69% increased risk of autism.
However, when controlling for confounding factors such as pre-existing mental health conditions, this risk became non-significant. This means the meta-analysis found no significant link between antidepressant use during pregnancy and a greater risk of autism and ADHD in children, after controlling for the mother’s mental health or other influencing factors such as genetics.
Dr Wing-Chung Chang, a professor at the University of Hong Kong and lead author of the study, said: “We know many parents-to-be worry about the potential impact of taking medication during pregnancy; our study provides reassuring evidence that commonly used antidepressants do not increase the risk of neurodevelopmental disorders such as autism and ADHD in children.
“While all medications carry risks, so too does stopping antidepressants during pregnancy due to an increased risk of relapse. Therefore, for women with moderate-severe depression, doctors and patients must carefully weigh the potential risks and benefits of continuing antidepressant treatment during pregnancy against the potential harms of untreated depression.
“Although our study found a small increase in the risk of autism and ADHD in the children of women who had used antidepressants during pregnancy, it also found that this risk disappeared when we accounted for other factors. The increased risk was also seen in the children of fathers who took antidepressants and of mothers with antidepressant use before, but not during, pregnancy.
“Together, this suggests that it is not the antidepressants themselves causing an increased risk in autism and ADHD but it is more likely to be due to other factors, including genetic predisposition to conditions such as ADHD, autism, and mental health conditions.”
The study also found no difference in risk between high and low doses of antidepressants. Limitations of the study included the lack of data on socioeconomic status, lifestyle risk factors and low birthrate. Furthermore, women who are prescribed antidepressants tend to have more severe depression than those who are not, so some bias may remain even after controlling for factors such as mental health status.
James Walker, a professor emeritus of obstetrics and gynaecology at the University of Leeds, said the research had helped to “cut through the noise” regarding recent concerns regarding whether medications taken by mothers during pregnancy could affect their babies.
“The practical message is straightforward” Walker said. “Women with moderate or severe depression should not stop their antidepressants in pregnancy out of fear of causing autism or ADHD. Depression that goes untreated in pregnancy carries real risks of its own, for the mother, the pregnancy and for the developing baby, including a higher chance of premature birth, postnatal depression and difficulties bonding with the baby. For milder depression, talking therapies and other non-medication approaches are usually tried first, in line with current guidelines. As always, decisions in pregnancy are personal and should be made with a clinician who knows the woman’s history.”
