title: Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children.
abstract: OBJECTIVE
  The association between the use of antidepressants during gestation and the risk of autism spectrum disorder (ASD) in children is still controversial. The etiology of ASD remains unclear, although studies have implicated genetic predispositions, environmental risk factors, and maternal depression.
  
  
  OBJECTIVE
  To examine the risk of ASD in children associated with antidepressant use during pregnancy according to trimester of exposure and taking into account maternal depression.
  
  
  METHODS
  We conducted a register-based study of an ongoing population-based cohort, the Québec Pregnancy/Children Cohort, which includes data on all pregnancies and children in Québec from January 1, 1998, to December 31, 2009. A total of 145,456 singleton full-term infants born alive and whose mothers were covered by the Régie de l'assurance maladie du Québec drug plan for at least 12 months before and during pregnancy were included. Data analysis was conducted from October 1, 2014, to June 30, 2015.
  
  
  METHODS
  Antidepressant exposure during pregnancy was defined according to trimester and specific antidepressant classes.
  
  
  METHODS
  Children with ASD were defined as those with at least 1 diagnosis of ASD between date of birth and last date of follow-up. Cox proportional hazards regression models were used to estimate crude and adjusted hazard ratios with 95% CIs.
  
  
  RESULTS
  During 904,035.50 person-years of follow-up, 1054 children (0.7%) were diagnosed with ASD; boys with ASD outnumbered girls by a ratio of about 4:1. The mean (SD) age of children at the end of follow-up was 6.24 (3.19) years. Adjusting for potential confounders, use of antidepressants during the second and/or third trimester was associated with the risk of ASD (31 exposed infants; adjusted hazard ratio, 1.87; 95% CI, 1.15-3.04). Use of selective serotonin reuptake inhibitors during the second and/or third trimester was significantly associated with an increased risk of ASD (22 exposed infants; adjusted hazard ratio, 2.17; 95% CI, 1.20-3.93). The risk was persistent even after taking into account maternal history of depression (29 exposed infants; adjusted hazard ratio, 1.75; 95% CI, 1.03-2.97).
  
  
  CONCLUSIONS
  Use of antidepressants, specifically selective serotonin reuptake inhibitors, during the second and/or third trimester increases the risk of ASD in children, even after considering maternal depression. Further research is needed to specifically assess the risk of ASD associated with antidepressant types and dosages during pregnancy.
authors.affiliation: Faculty of Pharmacy, University of Montréal, Montréal, Québec, Canada2Research Unit on Medications and Pregnancy, Research Center, CHU Sainte-Justine, Montréal, Québec, Canada.
authors.forename: Takoua
authors.initials: T
authors.lastname: Boukhris
authors.affiliation: Research Unit on Medications and Pregnancy, Research Center, CHU Sainte-Justine, Montréal, Québec, Canada.
authors.forename: Odile
authors.initials: O
authors.lastname: Sheehy
authors.affiliation: Centre d'excellence en Troubles Envahissants du Développement de l'Université de Montréal, Montréal, Québec, Canada4Département de Psychiatrie, Hôpital Rivière-des-Prairies, Montréal, Québec, Canada5Centre de Recherche de l'Institut Universitaire de Psych.
authors.forename: Laurent
authors.initials: L
authors.lastname: Mottron
authors.affiliation: Faculty of Pharmacy, University of Montréal, Montréal, Québec, Canada2Research Unit on Medications and Pregnancy, Research Center, CHU Sainte-Justine, Montréal, Québec, Canada.
authors.forename: Anick
authors.initials: A
authors.lastname: Bérard
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects*; D000067877:Autism Spectrum Disorder / Q000139:chemically induced* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003863:Depression / Q000188:drug therapy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011248:Pregnancy Complications; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced* / Q000453:epidemiology; D016016:Proportional Hazards Models; D011792:Quebec; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors