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Antidepressant Use in Pregnancy Tied to Autism Risk

But the risk is low, and it's important to treat depression in pregnant women, experts say

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The current study included 966 mother-child pairs. Nearly 800 children were male. The average age of the children at the time of the study was nearly 4 years. About 500 of the children had an autism spectrum disorder, 154 had some type of developmental delay and 320 were typically developing children.

SSRI exposure was lowest in the typically developing children, with just 3.4 percent exposed during pregnancy. For those with autism, SSRI exposure occurred in 5.9 percent of pregnancies and SSRI exposure occurred in 5.2 percent of pregnancies for children with developmental delays.

When the researchers looked at boys and girls together, there was a trend toward a higher risk of autism and developmental delay. Lee noted that most of the study children were male, and said that they'd need a larger sample with more girls to get a better idea of the overall risk.

However, when the researchers separated the data on boys and girls, they found that boys with autism were three times more likely to have been exposed to SSRIs in pregnancy, and the rate was highest for those exposed during the first trimester, according to the study.

The study authors also found that boys with developmental delays were three to five times more likely to have been exposed to SSRIs during pregnancy compared to typically developing children. Rates were highest with exposure during the third trimester.

"This study suggests that there are some risks associated with SSRI exposure and that the risk is higher in boys. They [the study authors] also found the risk is highest with exposure during the first trimester when early brain development is occurring," said Dr. Eric Hollander, director of the autism and obsessive-compulsive disorder program at Montefiore Medical Center, in New York City.

Hollander noted that even if other research confirms the much higher risk for boys after SSRI exposure, women should know the risk is still low. "If the risk of autism is around 1 percent now, and you raise it to 3 percent, that still means that 97 percent of the time, you won't have an autism spectrum disorder. The chances are still overwhelming that they won't have a child with an autism spectrum disorder," he said.

Reproductive psychiatrist Dr. Ariela Frieder, also from Montefiore Medical Center, said this study's findings won't change her clinical practice.

"[This study] shows an association between the use of SSRIs and autism spectrum disorders. However, association does not mean causation, and this is very important for women to understand," she said.

Dr. Eyal Shemesh, chief of behavioral and developmental health in the department of pediatrics at the Mount Sinai Kravis Children's Hospital, in New York City said: "It's very hard to do a definitive study of this. The confounders here are huge. They [the study authors] initially found no difference between the groups -- it was only when they looked specifically at gender-adjusted differences that they saw an association. We still don't know whether SSRIs are associated with more autism. We need to look further."

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