1. Mothers’ prenatal selective serotonin reuptake inhibitor (SSRI) use was linked to an increased risk of autism spectrum disorder (ASD) in male children.
2. The risk of ASD was highest among those mothers who used SSRIs in the first trimester.
Evidence Rating Level: 3 (Average)
Study Rundown: SSRIs can cross the placenta to increase serotonin levels in the fetus and affect early brain development. Increased serum serotonin has been found in children with autism, a disorder that continues to rise in prevalence and currently affects 1/68 children.1 This study examined mothers’ prenatal SSRI use and the developmental status of their children (autism spectrum disorder [ASD], developmental delay [DD], or typical development [TD]). Prenatal exposure to SSRIs was nearly three-fold higher in boys with ASD compared to those with TD; this association was highest with SSRI use in the first trimester. Boys with DD also had increased exposure to SSRIs compared to those with TD, especially with use in the third trimester. This study was limited by recall bias and the inability to separate the effect of SSRIs from indication for use. Though prenatal SSRI use may increase risks of ASD or DD, untreated psychiatric conditions also hold significant risks for the fetus.
In-Depth [case-control study]: A total of 966 mother-child pairs (492 ASD, 154 DD, and 320 TD) from the Childhood Autism Risks from Genetics and the Environment (CHARGE) Study were examined. Controls were matched by age, gender, and regional care center. Validated tools confirmed diagnoses of ASD (Autism Diagnostic Interview-Revised [ADI-R], Autism Diagnostic Observation Schedule [ADOS]) and DD (Vineland Adaptive Behavior Scales, Mullen Scales of Early Learning). Controls were screened for both DD and ASD. Forty-eight (5%) mothers self-reported SSRI use during pregnancy. When stratified by gender, boys with ASD had significantly higher exposure to prenatal SSRIs compared to boys with TD (adjusted odds radio [aOR]: 2.92; 95% CI: 1.07-7.93). This association was highest with first trimester exposure (aOR: 3.22; 95% CI: 1.17-8.84). Boys with DD also had higher exposure compared to boys with TD (aOR: 3.39; 95% CI: 0.98-11.75); however, this was statistically significant only with third trimester use (aOR: 4.98; 95% CI: 1.20-20.62).
1 Prevalence of autism spectrum disorder among children aged 8 years – autism and developmental disabilities monitoring network, 11 sites, United States, 2010. MMWR Surveill Summ. 2014;63 Suppl 2:1-21.
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