December 12, 2017
Antidepressants During Pregnancy and Autism: Is There a Link?

Antidepressants During Pregnancy and Autism: Is There a Link?

by Keng Lam  

Women who take antidepressants may have been dismayed by recent news linking the use of those drugs in pregnancy to an increased risk of autism in children. While the findings may sound scary, it’s important that pregnant women not stop antidepressant medications without carefully weighing the risks and benefits first.

A review article published in JAMA Pediatrics in June 2017 examined 10 studies that looked at antidepressant exposure and autism spectrum disorders. It found that there is an association between a mother’s use of antidepressants during pregnancy and her child developing autism. Interestingly, the researchers found that the risk was most pronounced for use of antidepressants prior to conception, rather than during the actual pregnancy. The authors noted that the studies they analyzed often had somewhat conflicting results, which limited their ability to draw strong conclusions.

One large study, conducted in Sweden and published in BMJ in July 2017, looked at data from more than 250,000 children living in Stockholm between 2001 and 2011. The researchers found that those whose mothers had a psychiatric disorder and took antidepressants while pregnant with them were more likely to develop autism compared with children whose mothers had a psychiatric disorder during pregnancy but did not take antidepressants. But the absolute risk was small in both groups—4.1 percent of children vs. 2.9 percent of children, respectively.

Another, even larger Swedish study was published in JAMA in April 2017 and examined data from over 1.5 million children born between 1996 and 2012. In this case, the authors found no increased risk for autism for the offspring if the mother took antidepressants during her first trimester of pregnancy, a vulnerable period for fetal development. For many physicians and mothers, this should be comforting to know.

Several points are worth noting when looking at the research on antidepressants and autism. First, the studies referenced above were observational, meaning they looked at association, not causation. We cannot conclude for sure based on the findings that the medication led to autism, because there are other possible factors that the investigators did not consider that could have influenced the outcome.

Second, in the worlds of both scientific research and news media, publication bias is a serious concern: That is, people tend to release and talk about studies that suggest something is risky, as opposed to studies that find nothing worrisome. Third, the absolute risk of a child having autism is small even if there is a slight increase in risk from taking antidepressants. In contrast, untreated depression or other psychiatric conditions can increase the mother’s risk for suicide, filicide, or lacking the motivation to care for herself and her loved ones.

Bottom line: Findings on the small increased risk of autism posed by taking an antidepressant during pregnancy are still unclear and even conflicting. Women should take the alarming media reports with a grain of salt. In contrast, it’s well known that maternal psychiatric conditions can affect the health and well-being of mother and baby alike. Women who have depression, an anxiety disorder, or another mental health concern should talk with their doctors about the relative benefits of staying on their antidepressant (or starting one) during pregnancy. And if you take an antidepressant for any reason, don’t ever stop it abruptly without consulting your physician first. Finally, as a general rule, pregnant women should review all prescription medications they take, as well as any over-the-counter drugs or supplements, with a doctor—preferably their obstetrician.

Also see Is Some Alcohol Okay in Pregnancy?