Pregnant and taking antidepressants? Don’t worry about neurodevelopment harm, study says

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CNN
 — 

Expectant mothers taking many common antidepressants need no longer worry the medication may harm their child’s future behavioral or cognitive neurodevelopment, according to a new study of over 145,000 women and their children across the United States followed for up to 14 years.

“Results of previous studies on this topic have presented conflicting results. Due to our large population size and careful study design, we believe that our study offers clarity that could help patients and providers make treatment decisions in pregnancy,” said study author Elizabeth Suarez, an instructor at the Center for Pharmacoepidemiology and Treatment Sciences at the Rutgers Institute for Health, Health Care Policy and Aging Research.

Antidepressant use during pregnancy was not associated with autism, attention-deficit hyperactivity disorder (ADHD), behavioral disorders, developmental speech, language, learning and coordination disorders or intellectual disabilities, according to the study published Monday in the journal JAMA Internal Medicine.

“We believe these results are reassuring when it comes to concerns about the potential effects on neurodevelopmental outcomes in children, especially for diagnoses that may be of greater concern to expectant parents like autism spectrum disorder,” Suarez said via email.

“This is truly an important paper. Women and health professionals are often concerned about antidepressants in pregnancy, and sometimes decide to suddenly stop these medications as soon as pregnancy becomes known,” said Carmine Pariante, professor of biological psychiatry at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, in a statement.

Instead, women with depression and other mental conditions for which antidepressants are prescribed should be told the risk in pregnancy “is not as high as previously thought,” said Pariante, who was not involved in the study.

“I am grateful for this study,” Dr. Tiffany Moore Simas, a member of the Committee on Clinical Practice Guidelines on Obstetrics for the American College of Obstetricians and Gynecologists, told CNN via email.

“One in 5 perinatal individuals will experience a mental health condition,” said Moore Simas, who was not involved in the study. “We must stop shaming them for doing what is needed to care for themselves. Healthy babies need healthy mothers.”

A controversial topic

Numerous studies over the decades have found associations between antidepressant use during pregnancy and developmental concerns in children, predominately autism and ADHD. But newer research has called the quality of that prior research into question. Many older studies were observational in nature and often failed to control for contributing factors such as obesity and other health conditions, environmental toxins, inflammation and even maternal stress.

Older research also failed to consider the impact on a developing fetus carried by a mother with uncontrolled depression, anxiety or another psychiatric disorder. Not treating a mother’s mental disorder has also been linked to “stillbirth, preterm birth, growth restriction and birthweight weight issues, impaired bonding, adverse neurodevelopmental outcomes, and increased risk of offspring mental health,” Moore Simas said.

Depressed women can also miss prenatal visits, skip meals, overuse alcohol or cigarettes, and in general fail to care for their growing fetus as they fail to care for themselves, experts say.

A very small number of antidepressants have been linked to an increased risk of birth defects, according to the US Centers for Disease Control and Prevention, so pregnant women should discuss their medication with their doctors.

“We did not consider other potential adverse outcomes in our study. Our results for neurodevelopmental disorders should be weighed with the risk of other outcomes – such as a potential small increase in risk of preterm birth – and the benefits of treatment,” Suarez said.

Despite the advance of knowledge showing little to any impact from most common antidepressants, many physicians and mothers-to-be are still wary of their use, Moore Simas said.

Consultations between pregnant people and their doctors regarding antidepressant use are often “framed in the context of the risk of the medications – despite the data overall being reassuring,” she said. “Conversations about medication use for mental health in pregnancy or otherwise needs to account for the risk of untreated disease.”

The American College of Obstetricians and Gynecologists meets regularly to update guidance on medications that are safe to use during pregnancy, a spokesperson told CNN, and will be reviewing recent research such as this new study.

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