title: Prenatal SSRI use and offspring with autism spectrum disorder or developmental delay.
abstract: OBJECTIVE
  To examine associations between prenatal use of selective serotonin reuptake inhibitors (SSRIs) and the odds of autism spectrum disorders (ASDs) and other developmental delays (DDs).
  
  
  METHODS
  A total of 966 mother-child pairs were evaluated (492 ASD, 154 DD, 320 typical development [TD]) from the Childhood Autism Risks from Genetics and the Environment (CHARGE) Study, a population-based case-control study. Standardized measures confirmed developmental status. Interviews with biological mothers ascertained prenatal SSRI use, maternal mental health history, and sociodemographic information.
  
  
  RESULTS
  Overall, prevalence of prenatal SSRI exposure was lowest in TD children (3.4%) but did not differ significantly from ASD (5.9%) or DD (5.2%) children. Among boys, prenatal SSRI exposure was nearly 3 times as likely in children with ASD relative to TD (adjusted odds ratio [OR]: 2.91; 95% confidence interval [CI]: 1.07-7.93); the strongest association occurred with first-trimester exposure (OR: 3.22; 95% CI: 1.17-8.84). Exposure was also elevated among boys with DD (OR: 3.39; 95% CI: 0.98-11.75) and was strongest in the third trimester (OR: 4.98; 95% CI: 1.20-20.62). Findings were similar among mothers with an anxiety or mood disorder history.
  
  
  CONCLUSIONS
  In boys, prenatal exposure to SSRIs may increase susceptibility to ASD or DD. Findings from published studies on SSRIs and ASD continues to be inconsistent. Potential recall bias and residual confounding by indication are concerns. Larger samples are needed to replicate DD results. Because maternal depression itself carries risks for the fetus, the benefits of prenatal SSRI use should be carefully weighed against potential harms.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and rharring@jhsph.edu.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Harrington
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and.
authors.forename: Li-Ching
authors.initials: LC
authors.lastname: Lee
authors.affiliation: Departments of Epidemiology, Psychiatry, and Mental Health, Johns Hopkins Medical Institutions, Baltimore, Maryland;
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Crum
authors.affiliation: Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts; and.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Zimmerman
authors.affiliation: Department of Public Health Sciences and the MIND Institute, University of California, Davis, Davis, California.
authors.forename: Irva
authors.initials: I
authors.lastname: Hertz-Picciotto
mesh_terms: D002140:California; D016022:Case-Control Studies; D002659:Child Development Disorders, Pervasive / Q000139:chemically induced* / Q000453:epidemiology*; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000139:chemically induced* / Q000453:epidemiology*; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011263:Pregnancy Trimester, Third; D011297:Prenatal Exposure Delayed Effects; D012737:Sex Factors
keywords: autism; developmental delay; epidemiology; pregnancy; selective serotonin reuptake inhibitors
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