Newer antidepressant use in pregnancy not linked to childhood asthma

1. In this retrospective cohort study of Danish mothers and children, maternal use of newer antidepressants (e.g. SSRIs, nefazodone, mirtazapine, venlafaxine, and roboxetine) during pregnancy was not associated with an increased risk of childhood asthma.

2. Maternal prenatal use of older antidepressants (e.g. tricyclic antidepressants) was associated with an approximately 25% increased risk of childhood asthma. 

Evidence Rating Level: 2 (Good)    

Study Rundown: Maternal depression has previously been associated with childhood asthma. Maternal use of antidepressants, which can cross the placenta, has been linked to persistent pulmonary hypertension in newborn infants and may affect development of the fetal respiratory system. This study sought to determine whether maternal antidepressant use is associated with asthma in children. During the 11 year study period, children born to mothers with depression in the prenatal period were found to have a 1.25-fold higher risk of developing childhood asthma. While maternal use of selective serotonin reuptake inhibitors (SSRIs) and other newer antidepressants were not associated with increased risk of asthma development in children, tricyclic antidepressants were associated with a 1.26-fold higher risk of asthma in children. This study is limited by the use of prescription and hospitalization diagnosis codes for the diagnosis of asthma rather than chart review, as well as the fact that prescription records for antidepressants may not accurately capture use and compliance of these medications in mothers. Nonetheless, these findings suggest that physicians should adequately treat maternal depression, as the newer classes of antidepressants may not increase risk of childhood asthma, while untreated maternal depression is linked to childhood asthma.

Click to read the study, published today in Pediatrics

Relevant Reading: Placental passage of antidepressant medications.

In-Depth [retrospective cohort]:  A total of 733 685 singleton birth children born from January 1, 1996 to December 31, 2007 were included in this study, along with their mothers. Data was obtained from the Danish National Patient Register, Danish National Prescription Registry, and Danish Psychiatric Central Register. Asthma was diagnosed in 84 683 children in the cohort; diagnosis was made in children at age >3 years by at least 2 prescriptions for antiasthmatic medications or 1 asthma hospital ICD-10 diagnosis. Of the total cohort, 21 371 were born to mothers who had a diagnosis of depression while pregnant, and 8 895 of these children were born to mothers who had been prescribed at least 1 antidepressant medication during her pregnancy. Analyses were adjusted for maternal country of origin, maternal age at delivery, maternal parity, maternal social status, maternal smoking during pregnancy, maternal history of asthma, gender of child, and year of birth. Compared to children of mothers with depression who were not prescribed antidepressants, children born to mothers on SSRI therapy did not have increased risk of asthma (HR 0.95; 95% CI 0.93-1.08). In contrast, children born to mothers who were on older antidepressants only (tricyclic antidepressants) had an increased risk of asthma (aHR 1.26; 95% CI 1.02-1.55). The combination of SSRI and older antidepressant use was associated with an even higher risk of asthma (aHR1.64; 95% CI 1.20-2.24).

Image: PD

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