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Antidepressants (SSRIs) During Pregnancy Increases Autism Risk by 3X for Boys

New research has just surfaced from Johns Hopkins indicating that there is likely a link between prenatal exposure to antidepressant drugs and autism spectrum disorder (ASD) as well as other developmental delays (DD) among boys. This is highly concerning for pregnant mothers who have made the choice to stay on antidepressants throughout their pregnancy, particularly the first trimester. Most people are aware of the fact that there are some risks associated with taking antidepressants while pregnant, but they probably didn’t think of autism as a potential risk.

Other risks associated with antidepressants and pregnancy include: birth defects and other psychiatric conditions. While going through antidepressant withdrawal can be quite a treacherous experience for a pregnant mother, who is dealing with significant psychological stress as a result of pregnancy, in some cases it may be necessary to ensure optimal health for the child. Researchers speculate that risk may be effectively mitigated if the mother is drug-free during the first trimester.

New Study (2014): SSRIs During Pregnancy Increase Autism Risk by 3X

Earlier studies had suggested that there may be link between autism and antidepressant usage during various stages of pregnancy. However, much of this early research was considered controversial and findings were often conflicted with opposing research. Therefore many doctors and patients alike dismissed their chances that taking an antidepressant during pregnancy could increase risk of autism.

Study: Researchers from the BSPH (Bloomberg School of Public Health) assessed 966 mother-child pairings. Of these pairings, 492 had autism, 154 had developmental delays, and 320 were considered to have normal development. They obtained this data from a “CHARGE” (Childhood Autism Risks from Genetics and the Environment) Study. They used standard protocols to determine developmental status of children. Additionally, they conducted interviews with biological mothers that confirmed: prenatal SSRI usage, health history, and various sociodemographics.

Results: Results from the study indicated that in normally developed children, the occurrence of prenatal SSRI usage was the lowest at 3.4%. This percentage wasn’t considered statistically significant when compared to prenatal SSRI usage among children with autism (5.9%) or developmental delays (5.2%).

However, when researchers accounted for differences between male and female babies, they discovered that boys (male babies) were more likely to develop autism as a result of SSRI usage during pregnancy. Researchers suggested that prenatal exposure to an SSRI antidepressant leads to up to a 3-fold increase in the likelihood of autism among boys (with a 95% confidence interval).

They were able to determine that the most significant factor of causing autism was a pregnant mother taking an SSRI antidepressant in the first-trimester of pregnancy. It should also be mentioned that among boys with developmental delays, the strongest association was a pregnant mother taking an SSRI antidepressant in the third trimester of pregnancy.

Note: It is important to note that most of the children in the study were boys including: 85.6% in the normally developed group, 82.5% of the autism spectrum group, and 65.6% in the developmentally delayed group. The study did include girls, but there was a significantly stronger effect among boys. Although some future studies may want to further analyze potential detriment posed to girls as a result of antidepressant usage during pregnancy, most evidence from this study suggests that there may be differences based on sex in reference to prenatal SSRI effects.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/24733881

Does this mean that taking antidepressants while pregnant causes autism?

In some cases, the answer is likely “yes.” There is a definitive association between taking antidepressants, specifically SSRI (Selective Serotonin Reuptake Inhibitors) and increased risk for autism and developmental delays among boys. Why doesn’t this finding hold true for girls too? Currently it is unknown as to why boys are more likely to develop autism as a result of antidepressant usage during pregnancy.

A glaringly obvious fact is that boys are nearly 5X as likely to develop autism as girls. The fact that boys are more likely to experience autism as a result of antidepressant usage could be resulting from the fact that they are more susceptible to developing the condition in the first place. The SSRI medication may make alterations within the womb and/or biological development that only increase susceptibility among boys.

Obviously in order to confirm the findings in this study, larger scale studies will need to be conducted. While analyzing 966 mother-child pairs is certainly a large number, greater numbers need to be analyzed in order to verify these results, particularly those regarding developmental delays.

Theory: Some researchers speculate that serotonin is a vital neurotransmitter in fostering early cortical development. They believe that SSRI exposure could alter natural serotonergic processing within the fetal brain and lead to abnormalities like autism and developmental delays. Oddly enough the number of individuals with autism spectrum disorder is on the rise. Now approximately 1 in 68 kids in the United States has autism and it is significantly more common among boys than girls.

Should you take an antidepressant during pregnancy?

This is an extremely tricky question because on one hand, there is potential for antidepressant drugs to detrimentally affect fetal development. On the other hand, going off of an antidepressant may make you more depressed, anxious, and moody – which can also detrimentally affect fetal development. Seems like a lose-lose situation, right? For many, deciding whether to avoid psychotropic drugs during pregnancy is extremely difficult.

Many women have taken antidepressants throughout their pregnancy and their child turned out fine. For others, their child may have experienced developmental delays and/or came to develop autism spectrum disorder as a result of their medication. Therefore if you are facing the quandary of deciding whether to take an antidepressant during pregnancy and/or various stages of pregnancy, be sure to consult a professional. You should always weigh potential benefits vs. potential drawbacks and make an informed decision.

Note: There are some SSRIs that should never be taken during pregnancy, including Paxil.  This drug is scientifically proven to cause birth defects and may lawsuits have been filed as a result.  Now the company explicitly warns any pregnant mothers to discontinue this medication during pregnancy.  New “Darwinian tests” are being conducted to further determine which drugs are more likely to be safe for pregnant mothers.

As antidepressant usage increases, so do cases of autism?

Could the significant increase in the number of antidepressant prescriptions have something to do with the increase in those with autism? Possibly. It is known that antidepressant usage is on the rise, therefore we are likely to have more pregnant women who end up staying with their SSRI treatment throughout pregnancy. And according to this new study, if the child is a boy, he may end up with autism as a result of the SSRI.

While autism can be caused by a number of other factors, this study does indicate that one likely cause is using antidepressants during pregnancy. It would be interesting if researchers examined other classes of antidepressants such as SNRIs and certain atypicals like Wellbutrin to determine whether they carry the same risks. Additionally it may be beneficial to assess other genres of psychotropic medications as well as other pharmaceuticals to determine whether they also pose potential risks.

In the future there may be genetic testing that can determine whether taking a particular medication is likely to pose a significant threat to optimal fetal development.  This testing may be accomplished using a similar protocol to that of GeneSight.  Currently though there is no way to predict risk on a case-by-case basis, but that may change as biotech continues to evolve.

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