New research suggests it does not increase the risk of neurodevelopmental disorders in children, but there is an association.
Research published in JAMA internal medicine shows that taking antidepressants during pregnancy does not increase the risk of children developing neurodevelopmental disorders.
However, raw data from Harvard Medical School reveals an association between antidepressants during pregnancy and neurodevelopmental problems, which could be an important marker for the need for early detection and intervention in exposed children. .
The study’s lead author, Dr. Elizabeth Suarez, said newsGP the research adds “clarity” to the discussion of antidepressant use during pregnancy.
“Antidepressants are one of the most commonly used medications during pregnancy and through the childbearing years. Therefore, the safety of antidepressants during pregnancy is of great interest to providers and patients alike,” he said. she declared.
“Many patients discontinue treatment because they fear the potential risks. We believe these results are reassuring and will help patients and providers balance the risks and benefits of treatment during pregnancy.
“We found that antidepressant use is unlikely to increase the risk of neurodevelopmental disorders in children, and any observed association is likely due to factors associated with antidepressant use, such as indication [depression, anxiety, etcetera]health and lifestyle factors associated with depression or anxiety, environmental and genetic risk factors.
Previous research has been conflicting on whether antidepressants increase the risk of neurodevelopmental disorders (NDD), autism spectrum disorders (ASD), and attention deficit hyperactivity disorder (ADHD).
Consulting obstetrician/gynecologist Associate Professor Alex Polyakov said newsGP this new research adds to existing knowledge.
“The study is reassuring but it is not new, it has been known for a while. Several studies have looked at this question,” he said.
“NDD results have been studied previously with similar results. NDD results for babies are the same whether the mothers take antidepressants or not.
The authors note that ASD is the most widely studied NDD in relation to exposure to antidepressants during pregnancy.
‘Studies using population-based registries in Nordic countries and Canadian provinces [report] estimates of a 20-80% increased risk of ASD with exposure to antidepressants,” they wrote.
‘But [those] analyzes suggest that confounding uncontrolled by indication and setting may be a likely explanation in some, but not all, of these studies.
The Harvard study analyzed a database of over two million pregnancies and categorized antidepressant exposure as at least a distribution from the 19th week of gestation, which is the approximate period of synaptogenesis in the fetus. , until childbirth.
More than 145,700 pregnancies were exposed to antidepressants, which included serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants. Exposure to individual antidepressants was assessed for the five most commonly used drugs (sertraline, fluoxetine, bupropion, citalopram, and escitalopram).
Outcomes studied included ASD, ADHD, specific learning disabilities, developmental speech and language disorders, developmental coordination disorders, intellectual disabilities and behavioral disorders.
Associate Professor Polyakov thinks the study was very good, but not without limitations.
“They may be relying on data that is not 100% accurate because they are looking at the distribution of antidepressants and some people may be buying them but not taking them,” he said.
“Others may be on medication that was prescribed to them before. Thus, granular details cannot always be fully worked out.
Women using antidepressants during pregnancy had a higher risk of having a child with NDD than people not using antidepressants, but after adjusting for a long list of potential confounders, no difference was found. been found.
Moreover, when they compared the results with stopping antidepressants and pregnancies with unexposed siblings, there was also no difference for all results. The authors state that this indicates an increased risk of NDD due to factors associated with antidepressant use during pregnancy, but not the drug itself.
Dr Rodney Petersen, a GP and obstetrician/gynaecologist in Canberra, said newsGP the study is reassuring.
‘[It] will reassure most women that if they need an antidepressant during pregnancy then [they] do not increase the risk of ADHD and neurodevelopmental problems in their child,” he said.
“As with all conditions in pregnancy, caution should be exercised with all types of treatments and medications.
“However, if treatment of a condition is necessary, a risk/benefit discussion should take place between the woman and her primary obstetric care provider.”
An estimated 1% of Australians have ASD and 0.5% have ADHD. In Australia, estimates of antidepressant use during pregnancy range between 1-2%, while in the United States it is closer to 8%.
The authors note that children exposed to antidepressants during pregnancy could be flagged for early screening and intervention, with the goal of improving outcomes for NDD.
Associate Professor Polyakov said that while the potential for NDDs in children should be kept in mind, it is important to remember that depression can have serious effects on a pregnancy.
“Depression is a serious condition, especially during pregnancy, and it can get worse during or especially after childbirth due to hormonal fluctuations,” he said.
“My personal approach is not to discontinue antidepressants. Ideally, we would approach their use pre-conceptually if possible and advise further monitoring by a psychiatrist if necessary.
“Untreated depression can affect self-care during pregnancy, [and] can affect family dynamics and newborn care. It is therefore extremely important to keep it under control.
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