Does prenatal exposure to Selective Serotonin Reuptake Inhibitors (SSRIs) increase the risk of neurodivergence?

From the Guidelines

Prenatal exposure to SSRIs does not substantially increase the risk of neurodivergence, such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) 1.

Key Findings

• Converging evidence from observational studies suggests that maternal antidepressant use during pregnancy either does not have any influence on offspring risk of ASD and ADHD or the influence on these outcomes is small and may not be clinically significant 1.
• Rodent studies have reported adverse effects of antidepressant exposure, but between-species differences may impact the translation of these findings to humans 1.
• Observed associations between prenatal antidepressant exposure and neurodevelopmental problems are largely due to other factors that differ between exposed and unexposed offspring, such as indications for maternal antidepressant use, environmental common causes, and biological pleiotropic genetic factors 1.

Clinical Implications

• The body of research to date indicates that prenatal antidepressants exposure is unlikely to have strong adverse effects for ASD and ADHD 1.
• Antidepressant use during pregnancy is relatively safe, particularly for risk of long-term neurodevelopmental outcomes 1.
• Women and their doctors can make informed decisions about antidepressant use during pregnancy, with reassurance that use of these medications during pregnancy is unlikely to substantially increase the risk ASD and ADHD 1.

From the Research

Prenatal Exposure to SSRIs and Neurodivergence

• Prenatal exposure to Selective Serotonin Reuptake Inhibitors (SSRIs) has been associated with an increased risk of neurodivergence, particularly Autism Spectrum Disorder (ASD) 2.
• A meta-analysis and systematic review found a significant association between prenatal SSRI exposure and ASD, with a pooled odds ratio of 1.82 (95% CI: 1.59-2.10) 2.
• Another study found that prenatal SSRI exposure was associated with altered brain development, particularly in regions critical to emotional processing, such as the amygdala and insula 3.
• A cohort study found that children prenatally exposed to SSRIs had less cerebral gray matter, particularly within the corticolimbic circuit, which persisted up to 15 years of age 4.
• However, the literature on the possible association of SSRIs with autism spectrum disorder is inconsistent, and some studies have found no significant cognitive impairments except for some transient gross motor delay, slight impairment of language abilities, and possibly behavioral changes 5.

Key Findings

• Prenatal SSRI exposure has been linked to an increased risk of ASD 2.
• Altered brain development, particularly in regions critical to emotional processing, has been observed in children prenatally exposed to SSRIs 3, 4.
• The risk of neurodivergence associated with prenatal SSRI exposure may be outweighed by the risk of untreated maternal depression 5.
• Further research is needed to fully understand the potential long-term behavioral and psychological outcomes of prenatal SSRI exposure 3, 4.

Study Limitations

• Many studies are confounded by the underlying maternal disease and by pharmacogenetic and pharmacokinetic differences of SSRIs 5.
• The literature on the possible association of SSRIs with autism spectrum disorder is inconsistent 5.
• More research is needed to fully understand the effects of prenatal SSRI exposure on neurodevelopmental outcomes 6, 5.