Antidepressants increase autism risk 87 percent

Using antidepressants during pregnancy greatly increases the risk of autism, a ground breaking study has found after looking at outcomes of 145,456 pregnancies where the moms used antidepressants.

Professor Anick Bérard PhD, of the University of Montreal and its affiliated CHU Sainte-Justine children's hospital, came to her conclusions after reviewing data from the Quebec Pregnancy Cohort covering 145,456 children between the time of their conception up to age ten. Dr. Bérard is the recipient of a FRQ-S research Chair on Medications and Pregnancy, and is a consultant for plaintiffs in litigations involving antidepressants and birth defects.

Some people are genetically predisposed to autism as is reflected in their family history. However, maternal age and depression are also known to be associated with the development of autism, as are certain socio-economic factors (poverty). The team was able to take all into consideration.

Bérard explains: "We defined exposure to antidepressants as the mother having had one or more prescription for antidepressants filled during the second or third trimester of her pregnancy. An infant's critical brain development occurs during this time. Amongst all children in the study, we identified hospital records diagnosing atypical autism, Asperger's syndrome, or pervasive developmental disorder. Finally, we looked for a statistical association and found a very significant one — an 87% increased risk. The variety of causes of autism remain unclear, but studies have shown that both genetics and environment can play a role."

All children were diagnosed by specialists such as psychiatrists and neurologists.

"Our study has established that taking antidepressants during the second or third trimester of pregnancy almost doubles the risk that the child will be diagnosed with autism by age 7, especially if the mother takes selective serotonin re-uptake inhibitors, often known by the acronym SSRIs."

Anick Bérard PhD, Professor, University of Montreal's School of Pharmacy, researcher at the CHU Sainte-Justine Research Centre.

Selective serotonin re-uptake inhibitors or serotonin-specific reuptake inhibitors[1] (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of major depressive and anxiety disorders. Source: Wikipedia

Types of SSRIs: Prozac, Celexa, Luvox, Zoloft, Paxil, Lexapro, Viibryd (an SSRI and 5HT1A receptor partial agonist), Brintellix (an SSRI that also targets several other serotonin receptors). Source: WebMd

Six to ten percent of pregnant Canadian women are currently being treated for depression with antidepressants. In the Bérard study, 1,054 children were diagnosed with autism on average by 4.5 years of age  — 0.72% of the children in the study. These findings are published in JAMA Pediatrics.

Moreover, the prevalence of autism amongst children has increased from 4 in 10,000 children in 1966, to 100 in 10,000 in 2015. While this increase may be attributed to both better detection and widening the criteria for an autism diagnosis, researchers believe that environmental factors are also playing a part.

"It is biologically plausible that anti-depressants are causing autism if used at the time of brain development in the womb, as serotonin is involved in numerous pre- and postnatal developmental processes, including cell division, migration of neurons, cell differentiation and synaptogenesis — or the creation of links between brain cells.

"Some classes of anti-depressants (SSRIs and some other antidepressants) work by inhibiting serotonin, which will have a negative impact on the ability of the brain to fully develop and adapt in-utero."

Anick Bérard PhD

The World Health Organization indicates that depression will be the second leading cause of adult death by 2020, which lead the researchers to believe antidepressants will likely remain widely prescribed, including during pregnancy.

"Our work contributes to a better understanding of the long-term neurodevelopmental effects of anti-depressants on children when they are used during gestation. Uncovering the outcomes of these drugs is a public health priority, given their widespread use," concludes Prof. Berard. 

Abstract
Importance 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.

Design, Setting, and Participants 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.

Exposures Antidepressant exposure during pregnancy was defined according to trimester and specific antidepressant classes.

Main Outcomes and Measures 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 and Relevance 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 of this study: Takoua Boukhris, Odile Sheehy, Laurent Mottron, MD, PhD, and Anick Bérard, PhD, published "Antidepressant use during pregnancy and the risk of autism spectrum disorder in children" in JAMA Pediatrics on December 14, 2015.

This study was supported by the Canadian Institutes of Health Reseach (CIHR) "Quebec Training Network in Perinatal Research", and the Fonds de la recherche du Québec - Santé (FRQ-S).,

Anick Bérard, PhD, is a professor at the University of Montreal's Faculty of Pharmacy and a researcher at the CHU Sainte-Justine Research Centre. Dr. Bérard is the recipient of a FRQ-S research Chair on Medications and Pregnancy. Dr Bérard is a consultant for plaintiffs in litigations involving antidepressants and birth defects.

Video: Taking anti-depressants during the second and third trimester of pregnancy increases the risk of the baby developping autism by 87%. Anick Bérard of the University of Montreal explains how she came to this finding and what it means for pregnant women.
https://www.youtube.com/watch?v=FbFIKMgHh2w

The University of Montreal is officially known as Université de Montréal.

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Dec 17, 2015   Fetal Timeline   Maternal Timeline   News   News Archive   

Using antidepressants during pregnancy greatly increases the risk of autism,
as found by Professor Anick Bérard of the University of Montreal and its
affiliate CHU Sainte-Justine children’s hospital.
Video of Dr.Bérard explaining her work.

Image Credit: University of Montreal