title: Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: population based case-control study.
abstract: OBJECTIVE
  To study the association between parental depression and maternal antidepressant use during pregnancy with autism spectrum disorders in offspring.
  
  
  METHODS
  Population based nested case-control study.
  
  
  METHODS
  Stockholm County, Sweden, 2001-07.
  
  
  METHODS
  4429 cases of autism spectrum disorder (1828 with and 2601 without intellectual disability) and 43,277 age and sex matched controls in the full sample (1679 cases of autism spectrum disorder and 16,845 controls with data on maternal antidepressant use nested within a cohort (n=589,114) of young people aged 0-17 years.
  
  
  METHODS
  A diagnosis of autism spectrum disorder, with or without intellectual disability.
  
  
  METHODS
  Parental depression and other characteristics prospectively recorded in administrative registers before the birth of the child. Maternal antidepressant use, recorded at the first antenatal interview, was available for children born from 1995 onwards.
  
  
  RESULTS
  A history of maternal (adjusted odds ratio 1.49, 95% confidence interval 1.08 to 2.08) but not paternal depression was associated with an increased risk of autism spectrum disorders in offspring. In the subsample with available data on drugs, this association was confined to women reporting antidepressant use during pregnancy (3.34, 1.50 to 7.47, P=0.003), irrespective of whether selective serotonin reuptake inhibitors (SSRIs) or non-selective monoamine reuptake inhibitors were reported. All associations were higher in cases of autism without intellectual disability, there being no evidence of an increased risk of autism with intellectual disability. Assuming an unconfounded, causal association, antidepressant use during pregnancy explained 0.6% of the cases of autism spectrum disorder.
  
  
  CONCLUSIONS
  In utero exposure to both SSRIs and non-selective monoamine reuptake inhibitors (tricyclic antidepressants) was associated with an increased risk of autism spectrum disorders, particularly without intellectual disability. Whether this association is causal or reflects the risk of autism with severe depression during pregnancy requires further research. However, assuming causality, antidepressant use during pregnancy is unlikely to have contributed significantly towards the dramatic increase in observed prevalence of autism spectrum disorders as it explained less than 1% of cases.
authors.affiliation: Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK. dheeraj.rai@bristol.ac.uk
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Rai
authors.forename: Brian K
authors.initials: BK
authors.lastname: Lee
authors.forename: Christina
authors.initials: C
authors.lastname: Dalman
authors.forename: Jean
authors.initials: J
authors.lastname: Golding
authors.forename: Glyn
authors.initials: G
authors.lastname: Lewis
authors.forename: Cecilia
authors.initials: C
authors.lastname: Magnusson
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000453:epidemiology* / Q000523:psychology; D002675:Child, Preschool; D015331:Cohort Studies; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D008607:Intellectual Disability / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013548:Sweden; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors