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. 2024 Dec;33(12):4273-4283.
doi: 10.1007/s00787-024-02460-4. Epub 2024 May 19.

Association between maternal antidepressant use during pregnancy and the risk of autism spectrum disorder and attention deficit hyperactivity disorder in offspring

Min-Jing Lee #  1   2   3 , Yi-Lung Chen #  4   5 , Shu-I Wu  6   7 , Chien-Wei Huang  8   9 , Michael E Dewey  10 , Vincent Chin-Hung Chen  11   12
Affiliations

Association between maternal antidepressant use during pregnancy and the risk of autism spectrum disorder and attention deficit hyperactivity disorder in offspring

Min-Jing Lee et al. Eur Child Adolesc Psychiatry. 2024 Dec.

Abstract

Prenatal antidepressant exposure has been reported to be associated with adverse neurodevelopmental outcomes, yet studies considering confounding factors in Asian populations are lacking. This study utilized a nationwide data base in Taiwan, enrolling all liveborn children registered in the National Health Insurance system between 2004 and 2016. Subjects were divided into two groups: antidepressant-exposed (n = 55,707)) and antidepressant-unexposed group (n = 2,245,689). The effect of antidepressant exposure during different trimesters on autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) was examined. Sibling controls and parallel comparisons by paternal exposure status were treated as negative controls. Additional sensitivity analyses were conducted to examine the effects of antidepressant exposure before and after pregnancy. Prenatal antidepressant exposure was associated with increased risks of ASD and ADHD in population-wide and adjusted analysis. However when comparing antidepressant-exposed children with their unexposed siblings, no differences were found for ASD (Hazard ratio [HR]: 1.04, 95% confidence interval [CI] 0.76-1.42 in first trimester; HR: 0.96, 95% CI 0.62-1.50 in second trimester; HR: 0.69, 95% CI 0.32-1.48 in third trimester) and ADHD (HR: 0.98, 95%CI 0.84-1.15 in first trimester; HR: 0.91, 95% CI 0.73-1.14 in second trimester; HR: 0.79, 95% CI 0.54-1.16 in third trimester). Increased risks for ASD and ADHD were also noted in paternal control, before and after pregnancy analyses. These results imply that the association between prenatal antidepressant exposure and ASD and ADHD is not contributed to by an intrauterine medication effect but more likely to be accounted for by maternal depression, genetic, and potential environmental factors.

Keywords: Antidepressant exposure; Attention-deficit hyperactive disorder; Autism spectrum disorder; Cohort study; Neurodevelopmental outcomes; Pregnancy.

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Conflict of interest statement

Declarations. Conflict of interest: The authors have no competing interests or financial support to disclose. Ethical standards: This study was approved by the Research Ethics Committee of China Medical University and Hospital (approval number: CMUH108-REC1-142) and was executed as per the Declaration of Helsinki. The requirement for informed consent was waived.

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