Use of selective serotonin reuptake inhibitors during breastfeeding is not associated with reduced cognitive performance in children

1. In this prospective cohort study, postpartum selective serotonin reuptake inhibitors (SSRIs) use during breastfeeding was not associated with reduced cognitive performance in children. 

2. IQ scores were similar among children breastfed with SSRI exposure compared to breastfed without SSRI exposure, and non-breastfed children. 

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Numerous studies have investigated the impact of maternal use of selective serotonin reuptake inhibitors (SSRIs) on the cognitive development of their children. However, research on the association between SSRI use during breastfeeding and mental development in children has been limited. Although SSRIs can transfer into breast milk, the exposure level is low and may be outweighed by the well-established benefits of breastfeeding. To address these gaps, this study compared preschool IQ scores across children with prenatal and breastfeeding SSRI exposure, prenatal-only exposure, and no breastfeeding. 

The primary outcomes of the study were the Full-Scale IQ (FSIQ), Verbal IQ (VIQ), and Performance IQ (PIQ) scores, measured using the appropriate version of the Wechsler Primary and Preschool Test of Intelligence (WPPSI). There was no significant association between exposure to SSRIs during breastfeeding and cognitive development. Breastfed children exposed to SSRIs had similar IQ performance compared to breastfed children who were not exposed to SSRIs. The volunteer-based study was limited and may therefore not be generalizable to the general population. Despite this limitation, this study found that SSRI exposure was not associated with lower cognitive scores and, before adjustment, was linked with somewhat higher IQ scores compared to non-breastfed children. 

Click here to read the study in JAMA Network Open 

Relevant Reading: Selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors in pregnancy: Infant and childhood outcomes

In-Depth [Prospective Cohort Study]: Eligible individuals include all English- and Spanish-speaking women in California who were unaware of the outcome of their pregnancy at the time of their visit. This study included 97 mother-child pairs (mean [SD] age at testing of 4.9 [0.7] years). Among these participants, 22 (22.7%) were exposed to SSRIs through breastfeeding, while 37 (38.1%) were breastfed without exposure to SSRIs, and 38 (39.2%) were not breastfed. Between the children who were breastfed, there was no significant difference in IQ scores between those with or without SSRI exposure. In the total population, the mean FSIQ was in the 62nd percentile (mean [SD] 105.8 [11.8]), the VIQ was in the 58th percentile (mean [SD] 103.9 [12.5]), and the PIQ was in the 64th percentile (mean [SD] 107.0 [13.0]). Children exposed to SSRIs through breastfeeding had an adjusted mean FSIQ of 109.4 (95% CI, 104.5-114.4), similar to breastfed children without SSRI exposure (106.1; 95% CI,102.1-110.1; P=.29) and 6.3 points higher than non-breastfed children (103.1; 95% CI, 99.3-106.9; P=.046). The adjusted mean PIQ of children exposed to SSRIs through breastfeeding (112.3; 95% CI, 106.7-118.0) was not significantly different from that of breastfed children without SSRI exposure (106.7; 95% CI, 102.3-111.1; P=.12), but 8.1 points higher than that of non-breastfed children (104.2; 95% CI, 99.9-108.5; P=.03). Overall, these findings support the safety of SSRI use during breastfeeding with respect to long term cognitive outcomes. 

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