title: Externalizing and attentional behaviors in children of depressed mothers treated with a selective serotonin reuptake inhibitor antidepressant during pregnancy.
abstract: OBJECTIVE
  To evaluate attentional and activity behaviors in 4-year-olds following prenatal selective serotonin reuptake inhibitor (SSRI) exposure.
  
  
  METHODS
  Prospective cohort design.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Twenty-two 4-year-olds with prolonged prenatal SSRI medication exposure and 14 children without prenatal exposure.
  
  
  METHODS
  Prenatal SSRI exposure.
  
  
  METHODS
  Group differences in externalizing behaviors (according to the Child Behavior Checklist) and direct observations of child attention, activity, and impulsiveness in a laboratory setting using the procedure by Crowell and colleagues were compared, including measures of the duration of prenatal SSRI exposure, umbilical cord drug levels, a history of poor neonatal adaptation, and maternal mood.
  
  
  RESULTS
  Externalizing behaviors did not differ between groups. Maternal depression and anxiety at the 4-year follow-up were associated with increased reports of externalizing behaviors. Increased externalizing behaviors were associated with increased umbilical cord drug levels (F(1,34) = 6.3; P = .02), but when controlling for maternal depressed mood at the 4-year follow-up, such levels only accounted for 11.2% of the behavioral outcomes (P>.05). On direct observation, the persistence score for child behavior was significantly lower in the exposed group. Increased aggressiveness scores were associated with a history of poor neonatal adaptation, even when parental report of stress was added to the model (F(1,34) = 4.0; P = .03); however, neither parental report of stress nor poor neonatal adaptation were significant (both P = .09), suggesting that both are important, if not unique, predictors of child behavior.
  
  
  CONCLUSIONS
  These findings suggest that the best predictors of externalizing behaviors at age 4 years are current maternal mood and parental stress, regardless of prenatal depressed mood and SSRI treatment during pregnancy. It remains uncertain whether poor neonatal adaptation can be excluded as a possible predictor of externalizing behaviors.
authors.affiliation: Department of Pediatrics, Human Early Experience Unit, Centre for Community Child Health Research, Research Institute for Children's and Women's Health, University of British Columbia, 4480 Oak Street, Vancouver, BC, Canada V6 3V4. toberlander@cw.bc.ca
authors.forename: Tim F
authors.initials: TF
authors.lastname: Oberlander
authors.forename: Pratibha
authors.initials: P
authors.lastname: Reebye
authors.forename: Shaila
authors.initials: S
authors.lastname: Misri
authors.forename: Michael
authors.initials: M
authors.lastname: Papsdorf
authors.forename: John
authors.initials: J
authors.lastname: Kim
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Grunau
mesh_terms: D000328:Adult; D001288:Attention / Q000187:drug effects*; D002652:Child Behavior / Q000187:drug effects*; D002675:Child, Preschool; D003863:Depression / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018811:Maternal Exposure / Q000009:adverse effects*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000523:psychology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors