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Prenatal antidepressant use and risk of attention-deficit/hyperactivity disorder in offspring: population based cohort study

Man, KKC; Chan, EW; Ip, P; Coghill, D; Simonoff, E; Chan, PKL; Lau, WCY; ... Wong, ICK; + view all (2017) Prenatal antidepressant use and risk of attention-deficit/hyperactivity disorder in offspring: population based cohort study. BMJ - British Medical Journal , 357 , Article j2350. 10.1136/bmj.j2350. Green open access

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Abstract

OBJECTIVE: To assess the potential association between prenatal use of antidepressants and the risk of attention-deficit/hyperactivity disorder (ADHD) in offspring. DESIGN: Population based cohort study. SETTING: Data from the Hong Kong population based electronic medical records on the Clinical Data Analysis and Reporting System. PARTICIPANTS: 190 618 children born in Hong Kong public hospitals between January 2001 and December 2009 and followed-up to December 2015. MAIN OUTCOME MEASURE: Hazard ratio of maternal antidepressant use during pregnancy and ADHD in children aged 6 to 14 years, with an average follow-up time of 9.3 years (range 7.4-11.0 years). RESULTS: Among 190 618 children, 1252 had a mother who used prenatal antidepressants. 5659 children (3.0%) were given a diagnosis of ADHD or received treatment for ADHD. The crude hazard ratio of maternal antidepressant use during pregnancy was 2.26 (P<0.01) compared with non-use. After adjustment for potential confounding factors, including maternal psychiatric disorders and use of other psychiatric drugs, the adjusted hazard ratio was reduced to 1.39 (95% confidence interval 1.07 to 1.82, P=0.01). Likewise, similar results were observed when comparing children of mothers who had used antidepressants before pregnancy with those who were never users (1.76, 1.36 to 2.30, P<0.01). The risk of ADHD in the children of mothers with psychiatric disorders was higher compared with the children of mothers without psychiatric disorders even if the mothers had never used antidepressants (1.84, 1.54 to 2.18, P<0.01). All sensitivity analyses yielded similar results. Sibling matched analysis identified no significant difference in risk of ADHD in siblings exposed to antidepressants during gestation and those not exposed during gestation (0.54, 0.17 to 1.74, P=0.30). CONCLUSIONS: The findings suggest that the association between prenatal use of antidepressants and risk of ADHD in offspring can be partially explained by confounding by indication of antidepressants. If there is a causal association, the size of the effect is probably smaller than that reported previously.

Type: Article
Title: Prenatal antidepressant use and risk of attention-deficit/hyperactivity disorder in offspring: population based cohort study
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/bmj.j2350
Publisher version: http://doi.org/10.1136/bmj.j2350
Language: English
Additional information: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Keywords: Science & Technology, Life Sciences & Biomedicine, Medicine, General & Internal, General & Internal Medicine, DEFICIT HYPERACTIVITY DISORDER, AUTISM SPECTRUM DISORDER, CONTROLLED CASE SERIES, ORAL FLUOROQUINOLONES, PSYCHIATRIC-DISORDERS, GENETIC INFLUENCES, HEALTH SYSTEM, ADHD, PREGNANCY, ASSOCIATION
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Practice and Policy
URI: https://discovery.ucl.ac.uk/id/eprint/1555738
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