Study Finds Antidepressants in Pregnancy Increase Risk for Speech Disorders

A new study published this week in JAMA Psychiatry indicates that infants are more likely to develop speech or language disorders if they are exposed to antidepressants during pregnancy. The researchers found that the children of women who took selective serotonin reuptike inhibitors (SSRIs), the most common type of antidepressant, during pregnancy had a 37% increased risk for language disorders, like dyslexia, when compared to depressed mothers who did not take the drugs.

While the relative risk remains low the increasing percentage of women taking antidepressants during pregnancy may result in a significant increase in these disorders across the population.

“When you have relative risks that are 1.37, they’re considered to be low. But because so many people are exposed — 6% to 10% of mothers are exposed (to antidepressants) throughout the world — it’s increasing the public health burden,” Alan Brown, the lead author of the study, told CNN.

It is understood that SSRIs cross the placental barrier and enter the bloodstream of the fetus. Animal studies have repeatedly found that exposure to SSRIs during critical periods of development can alter fetal brain development and can lead to motor deficits and cognitive impairments. Recent research on humans has found increased risks related to cognition as well, including increased occurrence of autism, neonatal adaptation syndrome, and depression in adolescence in children exposed to SSRIs in utero – though relative risks remain low.

This latest study analyzed population-based register data from Finland between 1996 and 2010 which included records on over 800,000 pregnant women with depression-related psychiatric diagnoses.  The researchers compared speech/language, scholastic, and motor disorders in offspring of depressed mothers who took SSRIs during pregnancy and those who did not.

“Using a large, national birth cohort observed from birth to 14 years, we have provided novel evidence of an association between speech/language disorders in offspring and SSRI use during pregnancy while accounting for maternal depression and other psychiatric disorders,” the authors write. “Offspring of mothers who purchased SSRIs at least twice during pregnancy had a significant 37% increased risk of speech/language disorders compared with offspring in the unmedicated group.”

The study, while including a very substantial sample, is limited by its design. It is possible, for instance, that women who purchased more than two prescriptions for SSRIs during pregnancy were experiencing a more severe form of depression than those who self-selected to not take antidepressants. Nonetheless, this study adds to a substantial body of research that should be considered by providers and patients when making a risk/benefit decision concerning the use of antidepressants in pregnancy.

Psychotherapy is supported as an effective first-line intervention for depression, including with pregnant women. Additionally, there is currently a paucity of research on the effects of withdrawing from antidepressants during pregnancy on the short and long term health of the fetus.

 

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Mad In America has often served as a forum for discussing research on the effects of antidepressants in pregnancy. As part of our newly launched Sunshine Project, we recently released a comprehensive review of the research literature on antidepressant use in pregnancy, and Mad In America Continuing Education (MIACE) offers a course by Dr. Adam Urato on the risks and possible harm to normal fetal development and the newborn child.

 

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Brown AS, Gyllenberg D, Malm H, McKeague IW, Hinkka-Yli-Salomäki S, Artama M, Gissler M, Cheslack-Postava K, Weissman MM, Gingrich JA, Sourander A. Association of Selective Serotonin Reuptake Inhibitor Exposure During Pregnancy With Speech, Scholastic, and Motor Disorders in Offspring. JAMA Psychiatry.Published online October 12, 2016. doi:10.1001/jamapsychiatry.2016.2594. (Abstract)