SSRI use during pregnancy not linked to increased risk of autism

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1. Serotonin selective reuptake inhibitors (SSRIs) during pregnancy did not increase the risk of autism spectrum disorder in offspring.   

Evidence Rating Level: 2 (Good) 

Study Rundown: Serotonin is a neurotransmitter that has been shown to influence neural development in animal studies. A recent small case-control study demonstrated that serotonin selective reuptake inhibitor (SSRI) use during pregnancy might increase the risk of autism spectrum disorder (ASD) in offspring. This finding was made plausible by the fact that SSRIs are known to cross the placenta.

In this recent large nationwide retrospective cohort study, there was no difference in the risk of ASD in offspring when comparing pregnant women who used SSRIs during pregnancy versus those who did not. This study extracted information from a nationwide Danish database and followed children from birth to up to 10 years of age, which makes this study larger and with lengthier follow up as compared to previous case-control studies.

However, there were also several confounding factors identified by this study as seen by difference between exposed versus non-exposed cohorts which included the psychiatric diagnosis indicating SSRIs, use of other psychiatric medications and self-reported smoking during pregnancy. Another limitation is that this study focused only on data collected from one nation and prior studies have shown that the rate of SSRI use during pregnancy varies between countries, thus the results may not be as generalizable. Future studies should revolve around examining the above-mentioned confounding factors (during pregnancy) on the future risk of ASD in offspring.

Click to read the study, published today in NEJM

In-Depth [retrospective cohort]: This study involved 626,875 live births/pregnancies from a nationwide Danish study over a span of 9 years. The pregnancy patients were divided into two cohorts (SSRI-exposed during pregnancy versus non-exposed during pregnancy) and their offspring were followed until the study’s end date or up to 10 years of age. The median age at diagnosis of ASD was 5.6 years. Exposure to SSRI was defined as during the period 4 weeks before the beginning of pregnancy through to delivery. Using the non-SSRI exposed group as reference, those who used SSRIs during pregnancy had an adjusted rate ratio of 1.20 (95% CI 0.90-1.61) and those who used SSRIs 2 years to 6 months before but not during pregnancy had a rate ratio of 1.46 (95% CI 1.17-1.81).

By Jonathan Liu, MD and Xu Gao

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