Antidepressant Exposure In Utero May Negatively Impact Motor Skills in 2-Year-Old Children

A new study in Frontiers of Pharmacology finds that antidepressant use during pregnancy is linked to reduced motor skills in children at 2 years old. The association, although mild, persists even when accounting for maternal depressive symptoms and stress during pregnancy. The current study, headed by Noémie Tanguay of the Université Laval in Québec, finds no such deficits in cognitive or language development. The authors write:

The goal of the current research was to examine associations between antidepressant use during pregnancy and child development at 2 years old while controlling for maternal depressive and anxiety symptoms. In other words, the authors wanted to ensure the associations they were seeing were related to antidepressant exposure rather than maternal depressive/anxiety symptoms.

To achieve this goal, the authors used data from the 3D Cohort Study of pregnant women in Quebec, Canada. Women were recruited for this research during the first trimester of pregnancy. In order to be included in the 3D cohort Study, women had to be between 18 and 47 years old and speak either French or English. Women were excluded due to current intravenous drug use, severe or life threatening illness, and multiple gestation pregnancies.

Additional inclusion criteria for the current research included the children being tested between 18 and 30 months for language development in either French, English, or Spanish. Children were excluded from the current research if they were diagnosed with a condition known to interfere with child development. In total, the current study included 1,489 mother-child pairs.

The authors used a maternal medication log to assess antidepressant use during each trimester as well as a questionnaire to collect data on antidepressant use in the three months prior to pregnancy. Demographic information was obtained through a prenatal questionnaire during the first trimester. Maternal depression/anxiety was measured using 2 self report surveys, the Center for Epidemiologic Studies – Depression Scale during the first trimester, and the Perceived Stress Scale during the second trimester. Cognitive and motor skills were measured in the children at 2 years of age using the Bayley Scales of Infant and Toddler Development — Third Edition (BSID-III). Language skills were evaluated using a short form of the MacArthur Communicative Development Inventories (MCDI) in which the parents reported which words their children could say from a list of 100 words.

4.1% of mothers reported antidepressant use during pregnancy. Of the participants using antidepressants, 96.2% reported daily use. The data showed a mild association between in utero antidepressant exposure and lower BSID-III scores at 2 years of age. Both fine and gross motor skills were effected. There was no association between in utero antidepressant exposure and cognitive skills as measured by the BSID-III or language skills as measured by the MCDI. Additionally, there was a marginal association between in utero antidepressant exposure and reduced cognitive ability, but this association was not present after multiple linear regression analysis.

The strongest associations found in the current research were for gestation duration and birthweight (longer gestation meant higher birthweight), and depressive symptoms and perceived stress (more perceived stress meant more depressive symptoms).

There was a mild association between maternal depressive symptoms and antidepressant use with a stronger (but still mild) association between antidepressant exposure and perceived stress. Maternal perceived stress was also weakly associated with lower scores for children in measurements of cognitive, fine motor, and language skills. Higher gestational age was marginally related to higher scores in measures of cognitive, language, and fine motor skills. Higher birthweight was marginally related to higher scores when measuring cognitive, fine motor, and gross motor skills.

The authors acknowledge several limitations to the current study. Antidepressant use was low in their participants. This means the researchers were not able to consider the dose, duration, type, or timing of antidepressant exposure in the current study. Medication logs were self reported by participants. This could lead to under-reporting due to misunderstanding or stigma around antidepressant use. The language assessment used only considered vocabulary. Additionally, the language assessment was based on reports by the parents rather than an objective measure of vocabulary. This research was conducted on women from Quebec, Canada with relatively high incomes and levels of education, significantly limiting generalizability to other populations. The authors conclude:

Previous research has linked in utero exposure to antidepressants to an increased risk for speech disorders, neonatal withdrawal syndrome, and poor neonatal outcomes. SSRI exposure in particular has been linked to reduced brain volume and delayed neonatal adaptation. The risks associated with antidepressant use during pregnancy are likely downplayed by many professionals. In an interview with Mad in America, Dr. Adam Urato emphasizes the importance of counseling around the use of psychopharmaceuticals during pregnancy due to the risks associated with these drugs.

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Tanguay N, Abdelouahab N, Simard M-N, Séguin JR, Marc I, Herba CM, MacLeod AAN, Courtemanche Y, Fraser WD and Muckle G (2023), Antidepressants use during pregnancy and child psychomotor, cognitive and language development at 2 years of age—Results from the 3D Cohort Study. Front. Pharmacol. 14:1252251. doi: 10.3389/fphar.2023.1252251 [full text]