SSRI Use During Pregnancy May Increase Risk of Language Delays in Offspring

Children of women who took selective serotonin reuptake inhibitors (SSRIs) during pregnancy may be at an elevated risk of speech and language disorders, according to a study published in JAMA Psychiatry in October. While experts say the study raises important questions, more research is needed to determine whether exposure to SSRIs confers greater risk than untreated depression during pregnancy over the long term.

Alan S. Brown, M.D., M.P.H., director of the Unit in Birth Cohort Studies at the New York State Psychiatric Institute, and colleagues tracked the incidence of speech/language, scholastic, and motor disorders from birth to 14 years in 56,000 children born in Finland between 1996 and 2010.

The offspring were divided into three groups: 15,596 were in the SSRI-exposed group (mothers diagnosed as having depression-related psychiatric disorders with a history of purchasing SSRIs during pregnancy); 9,537 were in the unmedicated group (mothers diagnosed as having depression-related psychiatric disorders without a history of purchasing SSRIs during pregnancy); and 31,207 were in the unexposed group (mothers without a psychiatric diagnosis or a history of purchasing SSRIs).

Over the study period, there was a total of 829, 187, and 285 instances of speech/language, scholastic, and motor disorders, respectively, in the three groups. The authors found that children in the SSRI-exposed group and the unmedicated group were at a significantly increased risk of speech/language disorders compared with those in the unexposed group.

Additional analysis revealed that children of mothers who purchased SSRIs at least twice during pregnancy had a 37 percent increased risk of speech/language disorders compared with offspring in the unmedicated group and a 63 percent increased risk compared with children in the unexposed group. There were no significant differences in the risk of the other disorders between offspring in the SSRI-exposed group and the unmedicated group.

“Overall the study is reassuring because there were no scholastic or motor associations, and the risk of language delay, if real, is very small,” Jennifer L. Payne, M.D., the director of the Women’s Mood Disorders Center at Johns Hopkins School of Medicine, told Psychiatric News. Payne, who is also an associate professor of psychiatry and behavioral sciences, was not involved in the study.

However, she noted that because the study did not control for severity of depression or postpartum depression, there is no way of knowing whether antidepressant exposure is actually associated with speech and language delays.

“Postpartum depression has long been known to affect language development and IQ in children,” she said.

In an accompanying editorial in JAMA Psychiatry, Lee Cohen, M.D., and Ruta Nonacs, M.D., Ph.D., of Massachusetts General Hospital wrote of the unknowns that remain regarding maternal use of SSRIs. “Brown et al. have identified a very important research question, … sbut the current report does not answer whether exposure to SSRIs or untreated depression during pregnancy is in equipoise with respect to neurodevelopmental toxicity or if, over the long term, one confers greater risk,” they wrote.

“Given the extent to which depression during pregnancy predicts risk for postpartum depression with its attendant morbidity, and in light of the robust data describing the adverse effects of maternal psychiatric morbidity on long-term child development, clinicians will need to broaden the conceptual framework used to evaluate relative risk of SSRI use during pregnancy as they navigate this clinical arena with patients making individual decisions to match patient wishes,” Cohen and Nonacs concluded.

The study was funded by the National Institutes of Health. ■

An abstract of “Association of Selective Ser-otonin Reuptake Inhibitor Exposure During Pregnancy With Speech, Scholastic, and Motor Disorders in Offspring” can be accessed here.