title: Gestational Exposure to Selective Serotonin Reuptake Inhibitors and Offspring Psychiatric Disorders: A National Register-Based Study.
abstract: To investigate the impact of gestational exposure to selective serotonin reuptake inhibitors (SSRIs) on offspring neurodevelopment.
  
  
  
  This is a cohort study using national register data in Finland between the years 1996 and 2010. Pregnant women and their offspring were categorized into 4 groups: SSRI exposed (n = 15,729); exposed to psychiatric disorder, no antidepressants (n = 9,651); exposed to SSRIs only before pregnancy (n = 7,980); and unexposed to antidepressants and psychiatric disorders (n = 31,394). We investigated the cumulative incidence of offspring diagnoses of depression, anxiety, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD) for the 4 groups from birth to 14 years, adjusting for confounders.
  
  
  
  The cumulative incidence of depression among offspring exposed prenatally to SSRIs was 8.2% (95% CI = 3.1-13.3%) by age 14.9 years, compared with 1.9% (95% CI = 0.9-2.9%) in the psychiatric disorder, no medication group (adjusted hazard ratio [HR] = 1.78; 95% CI = 1.12-2.82; p = .02) and to 2.8% (95% CI = 1.4-4.3%) in the SSRI discontinued group (HR = 1.84; 95% CI = 1.14-2.97; p = .01). Rates of anxiety, ASD, and ADHD diagnoses were comparable to rates in offspring of mothers with a psychiatric disorder but no medication during pregnancy. Comparing SSRI exposed to unexposed individuals, the HRs were significantly elevated for each outcome.
  
  
  
  Prenatal SSRI exposure was associated with increased rates of depression diagnoses in early adolescence but not with ASD or ADHD. Until confirmed, these findings must be balanced against the substantial adverse consequences of untreated maternal depression.
authors.affiliation: Teratology Information and Clinical Pharmacology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Child Psychiatry, University of Turku, Turku, Finland. Electronic address: heli.malm@hus.fi.
authors.forename: Heli
authors.initials: H
authors.lastname: Malm
authors.affiliation: Columbia University College of Physicians and Surgeons, New York; Columbia University Mailman School of Public Health, New York; Sackler Institute for Developmental Psychobiology, New York State Psychiatric Institute, Columbia University, New York; Division of Epidemiology, New York State Psychiatric Institute, New York.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Brown
authors.affiliation: Department of Child Psychiatry, University of Turku, Turku, Finland; National Institute for Health and Welfare, Helsinki, and Nordic School of Public Health, Gothenburg, Sweden.
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
authors.affiliation: Department of Child Psychiatry, University of Turku, Turku, Finland; University of Helsinki and Helsinki University Hospital and New York State Psychiatric Institute and Columbia University, New York.
authors.forename: David
authors.initials: D
authors.lastname: Gyllenberg
authors.affiliation: Department of Child Psychiatry, University of Turku, Turku, Finland.
authors.forename: Susanna
authors.initials: S
authors.lastname: Hinkka-Yli-Salomäki
authors.affiliation: Columbia University Mailman School of Public Health, New York.
authors.forename: Ian W
authors.initials: IW
authors.lastname: McKeague
authors.affiliation: Columbia University College of Physicians and Surgeons, New York; Columbia University Mailman School of Public Health, New York; Sackler Institute for Developmental Psychobiology, New York State Psychiatric Institute, Columbia University, New York; Division of Epidemiology, New York State Psychiatric Institute, New York.
authors.forename: Myrna
authors.initials: M
authors.lastname: Weissman
authors.affiliation: Columbia University College of Physicians and Surgeons, New York; Columbia University Mailman School of Public Health, New York; Sackler Institute for Developmental Psychobiology, New York State Psychiatric Institute, Columbia University, New York; Division of Epidemiology, New York State Psychiatric Institute, New York.
authors.forename: Priya
authors.initials: P
authors.lastname: Wickramaratne
authors.affiliation: Finnish Cancer Registry, Helsinki.
authors.forename: Miia
authors.initials: M
authors.lastname: Artama
authors.affiliation: Columbia University College of Physicians and Surgeons, New York; Sackler Institute for Developmental Psychobiology, New York State Psychiatric Institute, Columbia University, New York.
authors.forename: Jay A
authors.initials: JA
authors.lastname: Gingrich
authors.affiliation: Department of Child Psychiatry, University of Turku, Turku, Finland; Turku University Central Hospital Turku, Finland; Columbia University College of Physicians and Surgeons, New York; Division of Epidemiology, New York State Psychiatric Institute, New York.
authors.forename: Andre
authors.initials: A
authors.lastname: Sourander
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology; D001289:Attention Deficit Disorder with Hyperactivity / Q000139:chemically induced* / Q000453:epidemiology; D000067877:Autism Spectrum Disorder / Q000139:chemically induced* / Q000453:epidemiology; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology; D003866:Depressive Disorder / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D018811:Maternal Exposure / Q000706:statistics & numerical data*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced* / Q000453:epidemiology; D012042:Registries; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: ADHD; ASD; SSRI; offspring depression; pregnancy