Antidepressant use during pregnancy and the risk of autism spectrum disorder in children
Open accessAbstract
IMPORTANCE: The association between the use of antidepressants during gestation and the risk of autism spectrum disorder (ASD) in children is still controversial. The etiology of ASD remains unclear, although studies have implicated genetic predispositions, environmental risk factors, and maternal depression. OBJECTIVE: To examine the risk of ASD in children associated with antidepressant use during pregnancy according to trimester of exposure and taking into account maternal depression. DESIGN, SETTING, AND PARTICIPANTS: We conducted a register-based study of an ongoing population-based cohort, the Québec Pregnancy/Children Cohort, which includes data on all pregnancies and children in Québec from January 1, 1998, to December 31, 2009. A total of 145,456 singleton full-term infants born alive and whose mothers were covered by the Régie de l'assurance maladie du Québec drug plan for at least 12 months before and during pregnancy were included. Data analysis was conducted from October 1, 2014, to June 30, 2015. EXPOSURES: Antidepressant exposure during pregnancy was defined according to trimester and specific antidepressant classes. MAIN OUTCOMES AND MEASURES: Children with ASD were defined as those with at least 1 diagnosis of ASD between date of birth and last date of follow-up. Cox proportional hazards regression models were used to estimate crude and adjusted hazard ratios with 95% CIs. RESULTS: During 904,035.50 person-years of follow-up, 1054 children (0.7%) were diagnosed with ASD; boys with ASD outnumbered girls by a ratio of about 4:1. The mean (SD) age of children at the end of follow-up was 6.24 (3.19) years. Adjusting for potential confounders, use of antidepressants during the second and/or third trimester was associated with the risk of ASD (31 exposed infants; adjusted hazard ratio, 1.87; 95% CI, 1.15-3.04). Use of selective serotonin reuptake inhibitors during the second and/or third trimester was significantly associated with an increased risk of ASD (22 exposed infants; adjusted hazard ratio, 2.17; 95% CI, 1.20-3.93). The risk was persistent even after taking into account maternal history of depression (29 exposed infants; adjusted hazard ratio, 1.75; 95% CI, 1.03-2.97). CONCLUSIONS AND RELEVANCE: Use of antidepressants, specifically selective serotonin reuptake inhibitors, during the second and/or third trimester increases the risk of ASD in children, even after considering maternal depression. Further research is needed to specifically assess the risk of ASD associated with antidepressant types and dosages during pregnancy.
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Other studies' positive results remained after adjustment, restriction, and propensity weighting aimed at confounding by indication.
“These positive findings in other studies persisted even after efforts to reduce confounding by indication through adjustment for maternal psychiatric condition (29, 31, 43, 44), restriction to mothers with psychiatric conditions (27–30, 32), and propensity weighting methods (30).”
From Maternal Psychiatric Conditions, Treatment With Selective Serotonin Reuptake Inhibitors, and Neurodevelopmental Disorders (2021) · cites this paper as [29]
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- Authors
- Boukhris, T., Sheehy, O., Mottron, L., & Bérard, A.
- Affiliations
- Centre Hospitalier Universitaire Sainte-Justine (CA)
- Hôpital Rivière-des-Prairies (CA)
- Corresponding author
- Bérard, Anick
- Venue
- JAMA Pediatrics
- Publisher
- American Medical Association (AMA)
- Published
- 2016-02-01
- Volume
- 170
- Issue
- 2
- Pages
- 117
- ISSN
- 1072-4710 (ISSN-L)
- 2168-6203
- OpenAlex
- W2217811624
- Cited by
- 297
- References
- 47
- Citations by year
- 2026: 7 · 2025: 12 · 2024: 13 · 2023: 16 · 2022: 20 · 2021: 18 · 2020: 43 · 2019: 30 · 2018: 43 · 2017: 37 · 2016: 57
- FWCI
- 48.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Pediatrics and Adolescent Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Keywords
- antidepressant use during pregnancy, autism spectrum disorder, selective serotonin reuptake inhibitors, maternal depression, prenatal drug exposure, sex differences in autism, drug safety in pregnancy, maternal education, maternal smoking, maternal alcohol use, maternal obesity, maternal diabetes
- MeSH terms
- Autism Spectrum Disorder, Antidepressive Agents, Child, Child, Preschool, Depression, Female, Humans, Infant, Male, Maternal-Fetal Exchange, Pregnancy, Pregnancy Complications, Pregnancy Trimester, Second, Pregnancy Trimester, Third, Prenatal Exposure Delayed Effects, Quebec, Risk Factors, Proportional Hazards Models, Selective Serotonin Reuptake Inhibitors
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