[Physician Comment] Children born to mothers with depression have more behavioral problems; depression meds in pregnancy not definitively linked with childhood neurodevelopment

Image: PD. Venlafaxine

Study author Dr. Irena Nulman, M.D. talks to 2 Minute Medicine Professor of Paediatrics, University of Toronto, Toronto, Ontario, Canada

“Untreated maternal depression is associated with adverse pregnancy outcomes for both the mother and neonate, and pharmacotherapy for depression during pregnancy involves weighing potential teratogenic risks of antidepressant medications against adverse effects of maternal depression.  

Since the study of the reproductive safety of antidepressants requires one to separate the effects of maternal depression from the effects of its pharmacological treatment, the present study employed the appropriate methodology in order to address this issue. This is the first study to evaluate children’s neurocognitive and behavioral abilities following prenatal exposure to venlafaxine, SSRIs, or untreated maternal depression. 

The study failed to find an effect of antidepressant medication on children’s intellectual or behavioral outcomes. Rather, it was found that untreated depression is associated with a high risk for postpartum depression and that fetal and childhood exposure to maternal depression were significant predictors of child behavior problems and may represent risk for long-term child psychopathology. 

Health care professionals should weigh the risks and benefits associated with antidepressants during pregnancy and consider pharmacotherapy, if clinically indicated.”

Key study points:

1. Children of women without depression had significantly higher scores on the verbal and full-scale measures of intelligence when compared to children of women whose depression was managed with psychotropic medication.

2. Children born to mothers with depression, regardless of management, had significantly higher scores on a standardized measure of behavioral problems, although this was only one of the many measures used in the study.

3. Severity of maternal depression was a significant predictor of maternally-reported child behavioral problems.

4. 80% of women without medical management experienced at least one post-partum depressive episode.

Primer: Women of childbearing age are at increased risk for major depressive disorder, an episodic, life-long mental illness. While some research investigating the effects of maternal depression on child development implicates antepartum depression in the diagnosis of pediatric depressive disorders and developmental delay, there are no clear guidelines regarding the management of depression in pregnant women. Physicians are often forced to weigh the potential ineffectiveness of psychotherapy against the unclear long-term effects of antidepressant pharmacotherapy on children when treating pregnant patients. The current study aimed to further elucidate the effects of maternal depression, with and without antidepressant management, on the neurodevelopment of children.

Background reading:  

1. Follow-up of children of depressed mothers exposed or not exposed to antidepressant drugs during pregnancy [The Journal of Pediatrics]

2. The impact of maternal depression in pregnancy on early child development [BJOG: An International Journal of Obstetrics and Gynaecology]

3. Antepartum and postpartum exposure to maternal depression: Different effect on different adolescent outcomes [The Journal of Child Psychology and Psychiatry]

This [prospective cohort] study: Three groups of pregnant women with depression, one taking venlafaxine (n=62), one taking selective serotonin reuptake inhibitors (SSRIs) (n=62), one with women who stopped taking antidepressant medication prior to becoming pregnant (n=54), and a control, nondepressed, nonmedicated group (n=62) were recruited through a clinical research and teaching program. Postpartum, women detailed their depressive symptoms. Children’s intelligence and behavior were assessed between the ages of 3 and 6 years old.

Those who discontinued their psychopharmacologic treatment experienced significantly more severe depression than those managed with venlafaxine (p<.001). Children of women without depression had significantly higher scores on the verbal / intelligence when compared to children of women whose depression was managed with venlafaxine or SSRIs (p<.001 and p<.05, respectively). Children of mothers medicated with SSRIs scored worse than those born to mothers without depression on the performance component of the intelligence testing (p<.05). Children born to mothers with depression, regardless of management, had significantly higher scores on only one standardized measure of behavioral problems (p=.03).

In sum: This study is the first of its kind to investigate a connection between intelligence in children born to women treated for depression during pregnancy. Women experiencing depression and taking medication throughout the course of their pregnancy were more likely to report having severe depression. In addition, women without depression had children with intelligence quotient scores significantly higher than those who took psychotropic medication during pregnancy. While these effects may implicate the role of in-utero psychotropic medication in intelligence development, it is not clear whether or not severe depression requiring pharmacologic management or the medication exposure are responsible for this association. This study also found higher levels of behavioral problems in children born to mothers with depression. However, this finding was based upon only one component of behavioral assessment and is further complicated by the use of self-report in mothers experiencing depressive symptoms along with depression severity being predictive of this measure’s score.

The researchers were unable to definitively connect antidepressant medication to neurodevelopmental outcomes, establishing the need for further scientific investigation. In addition, a large portion of women with untreated depression experienced post-partum depression, a known contributor to poor emotional outcomes in children later in life. This finding highlights the need for adequate treatment of maternal depression.

Click to read the study in [The American Journal of Psychiatry]

Click to read an accompanying editorial in [The American Journal of Psychiatry]

By [LHC] and [MS] 

More from this author: Nutrient-enriched formula linked to increased head circumference and lower fat mass in a subset of preterm infants, Prophylactic probiotic use trends toward decreased incidence of nosocomial infections in preterm infants, Increases in CT scan usage in children with abdominal pain were not accompanied by changes in hospital admission rates or appendicitis diagnosis rates

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