title: Association of Selective Serotonin Reuptake Inhibitor Exposure During Pregnancy With Speech, Scholastic, and Motor Disorders in Offspring.
abstract: OBJECTIVE
  Speech/language, scholastic, and motor disorders are common in children. It is unknown whether exposure to selective serotonin reuptake inhibitors (SSRIs) during pregnancy influences susceptibility to these disorders.
  
  
  OBJECTIVE
  To examine whether SSRI exposure during pregnancy is associated with speech/language, scholastic, and motor disorders in offspring up to early adolescence.
  
  
  METHODS
  This prospective birth cohort study examined national population-based register data in Finland from 1996 to 2010. The sampling frame includes 845 345 pregnant women and their singleton offspring with data on maternal use of antidepressants and depression-related psychiatric disorders during pregnancy.
  
  
  METHODS
  There were 3 groups of offspring: 15 596 were in the SSRI-exposed group, ie, had mothers diagnosed as having depression-related psychiatric disorders with a history of purchasing SSRIs during pregnancy; 9537 were in the unmedicated group, ie, had mothers diagnosed as having depression-related psychiatric disorders without a history of purchasing SSRIs during pregnancy; and 31 207 were in the unexposed group, ie, had mothers without a psychiatric diagnosis or a history of purchasing SSRIs.
  
  
  METHODS
  Cumulative incidence of speech/language, scholastic, or motor disorders (829, 187, and 285 instances, respectively) from birth to 14 years. All hypotheses tested were formulated before data collection.
  
  
  RESULTS
  Of the 56 340 infants included in the final cohort, 28 684 (50.9%) were male and 48 782 (86.6%) were 9 years or younger. The mean (SD) ages of children at diagnosis were 4.43 (1.67), 3.55 (2.67), and 7.73 (2.38) for speech/language, scholastic, and motor disorders, respectively. Offspring of mothers who purchased SSRIs at least twice during pregnancy had a significant 37% increased risk of speech/language disorders compared with offspring in the unmedicated group. The cumulative hazard of speech/language disorders was 0.0087 in the SSRI-exposed group vs 0.0061 in the unmedicated group (hazard ratio, 1.37; 95% CI, 1.11-1.70; P = .004). There was a significantly increased risk of these disorders in offspring in the SSRI-exposed and unmedicated groups compared with offspring in the unexposed group. For scholastic and motor disorders, there were no differences between offspring in the SSRI-exposed group and in the unmedicated group.
  
  
  CONCLUSIONS
  Exposure to SSRIs during pregnancy was associated with an increased risk of speech/language disorders. This finding may have implications for understanding associations between SSRIs and child development.
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York2Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York3Division of Epidemiology, New York State Psychiatric Institute, New York4Sackler Institute for Developmental Psychobiology, Columbia University College of Physicians and Surgeons, New York, New York5New York State Psychiatric Institute, New York.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Brown
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York3Division of Epidemiology, New York State Psychiatric Institute, New York6Department of Child Psychiatry, University of Turku, Turku, Finland.
authors.forename: David
authors.initials: D
authors.lastname: Gyllenberg
authors.affiliation: Department of Child Psychiatry, University of Turku, Turku, Finland7Teratology Information Service, University of Helsinki and Helsinki University Hospital, Helsinki, Finland8Department of Clinical Pharmacology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Heli
authors.initials: H
authors.lastname: Malm
authors.affiliation: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York.
authors.forename: Ian W
authors.initials: IW
authors.lastname: McKeague
authors.affiliation: Department of Child Psychiatry, University of Turku, Turku, Finland10Department of Child Psychiatry, Turku University Central Hospital, Turku, Finland.
authors.forename: Susanna
authors.initials: S
authors.lastname: Hinkka-Yli-Salomäki
authors.affiliation: Department of Child Psychiatry, University of Turku, Turku, Finland11Helsinki University, Helsinki, Finland.
authors.forename: Miia
authors.initials: M
authors.lastname: Artama
authors.affiliation: Department of Child Psychiatry, University of Turku, Turku, Finland12National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York3Division of Epidemiology, New York State Psychiatric Institute, New York5New York State Psychiatric Institute, New York.
authors.forename: Keely
authors.initials: K
authors.lastname: Cheslack-Postava
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York4Sackler Institute for Developmental Psychobiology, Columbia University College of Physicians and Surgeons, New York, New York5New York State Psychiatric Institute, New York.
authors.forename: Myrna M
authors.initials: MM
authors.lastname: Weissman
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York4Sackler Institute for Developmental Psychobiology, Columbia University College of Physicians and Surgeons, New York, New York5New York State Psychiatric Institute, New York.
authors.forename: Jay A
authors.initials: JA
authors.lastname: Gingrich
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York3Division of Epidemiology, New York State Psychiatric Institute, New York6Department of Child Psychiatry, University of Turku, Turku, Finland10Department of Child Psychiatry, Turku University Central Hospital, Turku, Finland.
authors.forename: Andre
authors.initials: A
authors.lastname: Sourander
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005387:Finland; D006801:Humans; D007805:Language Development Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D007859:Learning Disabilities / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D000068079:Motor Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000453:epidemiology; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced* / Q000523:psychology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D013064:Speech Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors