title: In utero exposure to antidepressants and the use of drugs for pulmonary diseases in children.
abstract: OBJECTIVE
  The use of antidepressants during pregnancy is common. Some studies suggest an association between in utero exposure to antidepressants and the occurrence of pulmonary diseases like asthma later in life. Serotonin reuptake inhibitors (SSRIs) as well tricyclic antidepressants (TCAs) are thought to be involved in the development of the respiratory rhythm generator (RRG) and the maturation of the formation of surfactant. In this study the use of drugs for pulmonary diseases in children who were exposed to antidepressants in utero were compared with non-exposed children.
  
  
  METHODS
  The pharmacy prescription database IADB.nl was used for a cohort study in which the use of drugs for pulmonary disease in children after in utero exposure to antidepressants (TCAs, SSRIs) was compared with children with no antidepressant exposure in utero. Drugs for pulmonary diseases were applied as a proxy for disturbed development of the respiratory tract.
  
  
  RESULTS
  A small though significant increase in the incidence risk ratio (IRR) of the use of drugs for pulmonary disease was found after any-time in utero exposure to SSRIs, adjusted for maternal use of antibiotics, of 1.17 (95 % CI 1.16-1.18). An increase was also seen when we looked specifically for the use of SSRIs in at least the first trimester (IRR = 1.18, 95 % CI 1.17-1.20). An increased IRR in the use of drugs for pulmonary disease was also seen when children were exposed to TCAs, but this was not statistically significant. However, in both groups our sample size was rather small. The effect size is modest and may also be confounded by maternal smoking.
  
  
  CONCLUSIONS
  In utero exposure to SSRIs leads to a statistically significant increase in the use of drugs for pulmonary diseases, especially when exposure occurred during the first trimester of pregnancy. The increase in the use of drugs for pulmonary disease may also be related to other factors. Therefore, further study is recommended.
authors: Department of Clinical Pharmacy, Isala Klinieken, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands. p.g.j.ter.horst@isala.nl
authors: P G J
authors: PG
authors: ter Horst
authors: H J
authors: HJ
authors: Bos
authors: L T W
authors: LT
authors: de Jong-van de Berg
authors: B
authors: B
authors: Wilffert
mesh_terms: D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D011307:Drug Prescriptions; D004363:Drug Utilization; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D018811:Maternal Exposure; D009426:Netherlands; D016017:Odds Ratio; D011247:Pregnancy; D011264:Pregnancy Trimesters; D011297:Prenatal Exposure Delayed Effects; D019141:Respiratory System Agents / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000929:Antidepressive Agents, Tricyclic; D019141:Respiratory System Agents; D017367:Selective Serotonin Reuptake Inhibitors