Women who take antidepressants during the late stages of pregnancy have an 87 percent increased risk of giving birth to a child who will be diagnosed with autism, according to a new study from researchers in Montreal. And for women who take the most common kind of antidepressant -- SSRIs, or selective-serotonin reuptake inhibitors -- the risk is increased 200 percent.
Lead researcher Anick Bérard of the University of Montreal said in a video released by the school that she wasn’t surprised to find an association between antidepressant use and autism diagnoses in children, but she was surprised that it was so high for the leading class of antidepressants.
"We were expecting, in a way, to find an association," said Bérard. "We were not expecting to find such a huge association between the most used class of antidepressants during pregnancy, which is the SSRI."
About one in 68 children will be diagnosed with autism today, according to the U.S. Centers for Disease Control and Prevention, a rate that has increased over the decades. While better diagnostic tools may account for some of this increase, researchers like Bérard are exploring whether environmental factors, like drug exposure in utero, may also contribute to the rising rates of autism.
In the U.S., about 4.5 percent of women use an antidepressant during pregnancy or in the three months before pregnancy. Prescription medication is also the most common treatment for depression in women of childbearing age (18 to 44 years).
Bérard's analysis spanned 145,456 births between 1998 and 2009, following up with each family when the child was an average of six years old. After controlling for factors like gestational diabetes and hypertension, family history of autism, wealth, maternal age, and a history of depression and other psychiatric disorders, they found that women who used any class of antidepressants in the second and/or third trimesters of pregnancy had an 87 percent increased risk of giving birth to a child who would eventually be diagnosed with autism.
Those who had taken SSRIs during the second and/or third trimester were more than twice as likely to have a child with autism as women who never took antidepressants. The study was published Monday in the journal JAMA Pediatrics.
“We were not expecting to find such a huge association between the most used class of antidepressants during pregnancy.”
What it means for pregnant women
In light of her findings, Bérard thinks that people in general should continue using antidepressants as needed, but that those who could become pregnant should take steps to plan their pregnancy and explore “other options” for treating their depression when pregnant. Exercise and psychotherapy, she pointed out, have been shown to help treat women with mild to moderate depression, and these women make up the majority of those taking antidepressants while pregnant, she said.
"I don’t want to scare women -- this is not the goal of the study -- or make them feel guilty in any way, shape or form, but I want to empower them,” she concluded. “I hope that these types of studies actually empower women. More information is always a good thing.”
Bérard’s research follows a 2014 study from Johns Hopkins University that found boys with autism were three times more likely to have been exposed to SSRIs in utero, as well as a 2014 meta-analysis of past research that also found support for an increased risk of autism among such children exposed to SSRIs in utero. However, like Bérard’s research, these two studies only showed an association, not a causal relationship between the two.
Like Bérard, Dr. Adam Urato, a maternal fetal medicine specialist at Tufts Medical Center in Boston who was not involved in the research, isn’t at all surprised at the strong link between SSRI use and autism in children. But he emphasized that these findings are no reason to ignore depression symptoms in pregnant women. Rather, he said, the numbers are a wake up call about how we approach mental health care in America.
"We in the United States, and I think worldwide, have developed a chemical approach to mental health," he told HuffPost. This approach is lucrative to the pharmaceutical industry, Urato said, but it’s also simply more convenient and cost-effective to send a woman to have a short visit with a psychiatrist and walk away with a prescription instead of investing in regular psychotherapy, which, as Bérard points out, is a non-chemical yet highly effective way to treat mild to moderate depression. We should be embracing this information, Urato said, not running away from it.
"What scares people -- and this is something I’ve been arguing about for a decade now -- is that they feel if we warn patients about this, if we warn them these chemicals might affect a baby’s brain, then a woman might stop her medication and kill herself," Urato said. But that’s not what this study is about, he said.
"This is about getting [pregnant women] the right information so they can make the best decisions for themselves,” said Urato. "Knowledge is power, and we need to accurately inform pregnant women and the public on this."
Don't give up on your meds just yet
Women shouldn't immediately decide to give up on antidepressants -- most of which need to be tapered off slowly -- just because of one study, writes Dr. Bryan King, program director of Seattle Children’s Autism Center. He emphasized in an editorial that accompanied Bérard’s study in JAMA that other studies have found a “genetic overlap” in people who have depression and people who have autism, and that those with a family history of depression also have an increased risk of autism in general.
In a blog post for the Autism Center, King emphasized that the study "does not provide a definitive answer as to whether antidepressants cause or even increase the risk for autism.” He also pointed out that when you break out the findings, the increased risk of autism diagnosis translates into one additional child born with autism for every 200 moms who continue taking their meds during pregnancy.
"I don’t think that in and of itself this study will or should fundamentally influence whether women decide to take antidepressants when they are depressed or at risk for depression during pregnancy,” King concluded. "Paradoxically, the findings could actually provide some additional reassurance for women with depression and their health care providers who are trying to navigate a path forward between a rock and hard place."
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