1. Children with in utero exposure to selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) demonstrated greater risk for developmental vulnerability.
2. The Early Development Instrument (EDI) may help clinicians identify at-risk children exposed to in utero antidepressants who may benefit from early childhood intervention.
Evidence Rating Level: 2 (Good)
Study Rundown: Few studies have examined the long-term neurodevelopmental effects of prenatal exposure to antidepressants and have largely had inconclusive results. Some studies have found that in utero antidepressant exposure may increase the risk of language and cognitive deficiencies and behavioral disorders whereas other studies have found no such correlation. To further investigate the neurodevelopmental effects of in utero antidepressant exposure, the authors of the present study used a Canadian population-based cohort to evaluate children’s scores on the Early Development Instrument (EDI) in kindergarten, a teacher-completed questionnaire with 5 domains. Mothers with a prenatal mood or anxiety disorder were separated into 2 groups – those who took SSRIs and/or SNRIs during pregnancy and those who did not. They found that in utero antidepressant exposure increased the risk of developmental vulnerability in the language and cognitive development domain and also increased the risk of overall vulnerability in 2 or more domains. Although this study does not take into account disease severity and how that may affect neurodevelopmental outcomes, the use of a standardized developmental assessment may allow pediatricians to identify children who may be suffering from the developmental consequences of in utero antidepressant exposure.
In-Depth [retrospective cohort]: The Manitoba Population Research Data Repository and the Drug Program Information Network were used to gather health information of the study population: mothers with prenatal mood or anxiety disorder in the 90 days before conception. Including only children that had a recorded EDI, the exposed group consisted of children with mothers who filled at least 2 SSRI and/or SNRI prescriptions (n = 528) in contrast to children with mothers who had no documented prescriptions of these medications (unexposed group, n = 2,522). The EDI is a neurodevelopmental assessment completed by the kindergarten teacher consisting of 104 parts and 5 major domains: physical health and well-being, language and cognitive development, social competence, emotional maturity, and communication skills and general knowledge. Results indicated that when compared to 16.16% of unexposed children, 21.43% of exposed children demonstrated developmental vulnerability in 2 or more domains (absolute risk difference = 5.27%; adjusted odds ratio = 1.43 with 95% confidence interval 1.08 – 1.90). As compared to 12% of unexposed children, ~13% of exposed children demonstrated developmental vulnerability in the language and cognitive development domains (absolute risk difference = 0.54%; adjusted odds ratio = 1.40 with 95% confidence interval 1.03 – 1.91). Exposure to in utero antidepressants showed no statistically significant correlation with developmental vulnerability in the physical health and well-being, social competence, emotional maturity, and communication skills and general knowledge domains.
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