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Antidepressants during pregnancy and autism in offspring: population based cohort study

Rai, D; Lee, BK; Dalman, C; Newschaffer, C; Lewis, G; Magnusson, C; (2017) Antidepressants during pregnancy and autism in offspring: population based cohort study. BMJ , 358 , Article j2811. 10.1136/bmj.j2811. Green open access

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Abstract

OBJECTIVES: To study the association between maternal use of antidepressants during pregnancy and autism spectrum disorder (ASD) in offspring. DESIGN: Observational prospective cohort study with regression methods, propensity score matching, sibling controls, and negative control comparison. SETTING: Stockholm County, Sweden. PARTICIPANTS: 254 610 individuals aged 4-17, including 5378 with autism, living in Stockholm County in 2001-11 who were born to mothers who did not take antidepressants and did not have any psychiatric disorder, mothers who took antidepressants during pregnancy, or mothers with psychiatric disorders who did not take antidepressants during pregnancy. Maternal antidepressant use was recorded during first antenatal interview or determined from prescription records. MAIN OUTCOME MEASURE: Offspring diagnosis of autism spectrum disorder, with and without intellectual disability. RESULTS: Of the 3342 children exposed to antidepressants during pregnancy, 4.1% (n=136) had a diagnosis of autism compared with a 2.9% prevalence (n=353) in 12 325 children not exposed to antidepressants whose mothers had a history of a psychiatric disorder (adjusted odds ratio 1.45, 95% confidence interval 1.13 to 1.85). Propensity score analysis led to similar results. The results of a sibling control analysis were in the same direction, although with wider confidence intervals. In a negative control comparison, there was no evidence of any increased risk of autism in children whose fathers were prescribed antidepressants during the mothers’ pregnancy (1.13, 0.68 to 1.88). In all analyses, the risk increase concerned only autism without intellectual disability. CONCLUSIONS: The association between antidepressant use during pregnancy and autism, particularly autism without intellectual disability, might not solely be a byproduct of confounding. Study of the potential underlying biological mechanisms could help the understanding of modifiable mechanisms in the aetiology of autism. Importantly, the absolute risk of autism was small, and, hypothetically, if no pregnant women took antidepressants, the number of cases that could potentially be prevented would be small.

Type: Article
Title: Antidepressants during pregnancy and autism in offspring: population based cohort study
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/bmj.j2811
Publisher version: https://doi.org/10.1136/bmj.j2811
Language: English
Additional information: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.
Keywords: Adolescent, Adult, Antidepressive Agents, Autistic Disorder, Child, Child, Preschool, Depressive Disorder, Female, Humans, Infant, Infant, Newborn, Male, Pregnancy, Pregnancy Complications, Prenatal Exposure Delayed Effects, Prospective Studies, Risk Factors, Sweden
UCL classification: UCL > Provost and Vice Provost Offices
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 Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/1567949
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