Pre- and Post-natal SSRI use during Pregnancy and Breastfeeding and Risk of ASD in Children

Background: Evidence indicates that serotonin is altered in children with ASD; however, little is known about the developmental effect of pre- or post-natal exposure to medications that act on the serotonin system. Objectives: To provide preliminary data about the developmental effects of maternal use of selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, prenatally and/or postnatally. Methods: From the Childhood Autism Risks from Genetics and the Environment (CHARGE) study, a large population-based case-control study, we examined a subset consisting of children whose mothers reported experiencing a mental health disorder pre- or post-natally. This group was composed of 32 children with autism spectrum disorder (ASD), 7 with developmental delay (DD), and 17 with typical development (TD). Children with ASD had an ADI-R and ADOS confirmed diagnosis; Vineland and Mullen scores were used to classify children as DD or TD. Exposure was defined as mothers who reported taking an SSRI at any time from 3 months prior to conception to the end of breastfeeding. Bivariate logistic regression was used to examine the association between SSRI use during the index period and developmental outcomes in children. Results: SSRIs were used by 56% of mothers who had children with ASD, 57% who had children with DD, and 65% who had children with TD. The odds of SSRI exposure was 0.70 (95% confidence interval (CI): 0.21-2.36) in the ASD group and 0.73 (95% CI: 0.12-4.39) in the DD group compared to the TD group. Conclusions: SSRI exposure was lowest in the ASD group, followed by the DD group, and was highest in the TD group. We are currently in the process of investigating the relationship between pre- and post-natal use of SSRIs and ASD with a larger sample size, the results of which will be reported and discussed.