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Speech problems linked to in utero SSRI exposure

Children whose mums bought SSRIs while pregnant had 67% higher risk of problems

Louise Prime

Thursday, 13 October 2016

Children whose mothers were depressed and took selective serotonin reuptake inhibitors (SSRIs) during pregnancy had a much higher risk than other children of developing speech and language disorders, US-led research set in Finland has found. But the authors of the study,* published today in JAMA Psychiatry, stressed that they had not proven a causal link and called for more research to rule out the effect of possible confounding factors.

It is already known that SSRIs cross the placenta, and their use during pregnancy is increasing. These researchers investigated the association between in utero exposure to SSRIs and the risk of speech/language, scholastic and motor disorders in children up to early adolescence. Using register data from Finland covering 1996 to 2010, they studied 56,340 infants whom they classified in three groups.

There were 31,207 children whose mothers neither had a psychiatric diagnosis, nor took an SSRI while pregnant – the ‘unexposed’ group. Mothers of the ‘unmedicated’ group of 9,537 children had been diagnosed as having depression-related psychiatric disorders or other psychiatric disorders associated with SSRI use, but had no history of purchasing SSRIs during pregnancy. The remaining 15,596 children were in the ‘SSRI-exposed’ group because their mothers were diagnosed as having depression-related psychiatric disorders with a history of purchasing SSRIs during pregnancy.

The average age of a diagnosis of speech/language disorders was 4.4 years old, for scholastic disorders it was 3.5 years and for motor disorders it was 7.7 years.

The researchers found that the risks of scholastic or motor disorders did not differ between the exposed and unmedicated groups of children. But they noted that children whose mothers had bought SSRIs at least twice during pregnancy had a 37% increased risk of speech/language difficulties, compared with children in the unmedicated group – and a 63% higher risk than children in the unexposed group. They commented: “There was a significantly increased risk of these disorders in offspring in the SSRI-exposed and unmedicated groups compared with offspring in the unexposed group.”

The authors pointed out that as their study was observational it could not show causality; nor could they confirm that any SSRIs bought were actually taken. But the association between SSRI purchase and speech/language disorders occurred only among mothers with more than one SSRI purchase during pregnancy.

They concluded: “We found a significant increase in the risk of speech/language disorders among offspring of mothers who purchased SSRIs at least twice during pregnancy compared with mothers diagnosed as having depression or other psychiatric disorders not treated with antidepressants. Further studies are necessary to replicate these findings and to address the possibility of confounding by additional covariates before conclusions regarding the clinical implications of the results can be drawn.”

Nevertheless, they added: “This finding may have implications for understanding associations between SSRIs and child development.”

* Brown AS, Gyllenberg D, Malm H, et al. Association of selective serotonin reuptake inhibitor exposure during pregnancy with speech, scholastic, and motor disorders in offspring. JAMA Psychiatry. Published online October 12, 2016. doi:10.1001/ jamapsychiatry.2016.2594.

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