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Maternal Depression, Antidepressant Use During Pregnancy, and Offspring Autism Spectrum Disorders: Population-Based Study

Thursday, 2 May 2013: 11:45
Meeting Room 1-2 (Kursaal Centre)
D. Rai1,2, B. Lee3, C. Dalman2, J. Golding4, G. Lewis1 and C. Magnusson2, (1)Academic Unit of Psychiatry, University of Bristol, Bristol, United Kingdom, (2)Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden, (3)Drexel University School of Public Health, Philadelphia, PA, (4)University of Bristol, Bristol, United Kingdom
Background:  Recent research has raised the possibility of a higher risk of autism spectrum disorder (ASD) in offspring of mothers prescribed selective serotonin reuptake inhibitor (SSRI) antidepressants during pregnancy. Further research is required to verify and provide further insights into this finding. 

Objectives:  To study i) the association between parental depression and maternal antidepressant use during pregnancy with offspring ASD;  ii) whether associations between antidepressant use and ASD are unique to SSRIs; and iii) whether the associations are similar for ASDs with or without intellectual disability (ID).

Methods:  A case-control record-linkage study nested within a cohort of all individuals 0-17 years living in Stockholm County between 2001 to 2007 (n=589,114), using data on parental depression and other characteristics prospectively recorded before the birth of the child. Maternal antidepressant data, recorded at the first antenatal interview was available for children born 1995 onwards. ASDs (n=4429 in complete sample, n=1679 with antidepressant use data) were identified using multisource case-ascertainment.

Results:  A maternal history of depression was associated with an increased risk of offspring ASD but in the smaller sample with available data, this association appeared to be confined to women reporting antidepressant use during pregnancy (adjusted OR=3.34, 95% CI (1.50-7.47), p<0.01). The associations were observable in mothers using SSRI as well as non-SSRI antidepressants, and all associations seemed to be driven by heightened risks in cases of ASD without ID, there being no increase in risk for ASD with ID. 

Conclusions:  Although it is impossible to rule out confounding by indication (i.e. depression severe enough to require antidepressants during pregnancy leading to ASD), this study adds to the evidence suggesting a potential association between in-utero exposure to antidepressants and ASD, and highlights that the associations are not unique to SSRI’s and are largely confined to cases of ASD without intellectual disability.

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