What are the Long-term Effects of Intrauterine Exposure to Antidepressants?

Research Question: What are the Long-term Effects of Intrauterine Exposure to Antidepressants?

ARTICLE 1:

Rommel, A.-S., Bergink, V., Liu, X., Munk-Olsen, T., & Molenaar, N. M. (2022). Long-term effects of intrauterine exposure to antidepressants on physical, neurodevelopmental, and psychiatric outcomes: The Journal of Clinical Psychiatry, 81(3). https://doi.org/10.4088/jcp.19r12965

In the study by Rommel et al. (2022), they performed a systematic review of thirty-four studies on the long-term outcomes of exposure during the prenatal stage to antidepressants. The objective was to identify a correlation between the long-term effects of prenatal antidepressant medication exposure of children at least four years old and older. The study was inclusive of the following types of antidepressant medications: serotonin reuptake inhibitors (SRI), selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), tricyclic antidepressants, and monoamine oxidase inhibitors, with the predominant medication type being SSRIs. The research discovered a linkage between in-utero exposure and outcomes affecting physical, psychiatric, and neurodevelopment in the children of the studies. The direct impact of long-term exposure was increased body mass index in the children.

One critique of this article is that while the researchers thoroughly examined the physical, psychiatric, and neurodevelopment of the children in the study, there are limitations. Psychiatric disorders often present themselves in early adulthood. The study examining children makes it harder to assess the psychiatric component and cannot determine a relationship between the exposure and psychiatric disorders. To aid in the validity of the research, these children should be re-examined as adults to identify any psychiatric correlation with exposure to the medications.

 

ARTICLE 2: 

Singal, D., Chateau, D., Struck, S., Lee, J. B., Dahl, M., Derksen, S., Katz, L. Y., Ruth, C., Hanlon-Dearman, A., & Brownell, M. (2020). In utero antidepressants and neurodevelopmental outcomes in Kindergarteners. Pediatrics, 145(5). https://doi.org/10.1542/peds.2019-1157

Singal et al. (2020) conducted a study of the mother-child couplet that had a live hospital birth in an eight-year time frame in Manitoba. The mother-child couplet met the criteria for the study if they had continuous health coverage and had at minimum one mood disorder. The data was administrative data that was de-identified to remove any protected health information. The study revealed that the children whose moms used SSRI and SNRI throughout the pregnancy were at increased risk of developmental, language, and cognitive deficits. Recommendations for early intervention for the children exposed to moms with depression on antidepressant medications throughout the pregnancy would aid in preventing educational challenges that may be faced in later years.

One critique of this article is that there are limitations to the study. The study selected moms who were prescribed at minimum one antidepressant drug throughout the pregnancy. However, there is no way to ensure that the moms comply with taking the prescribed medication. The study recognized this limitation and included those who had two or more medications dispensed throughout the pregnancy. The study was also conducted in a less affluent area, and socio-economic could be a contributing factor.

 

ARTICLE 3: 

Singal, D., Brownell, M., Chateau, D., Ruth, C., & Katz, L. Y. (2016). Neonatal and childhood neurodevelopmental, health and educational outcomes of children exposed to antidepressants and maternal depression during pregnancy: Protocol for a retrospective population-based cohort study using linked administrative data. BMJ Open, 6(11). https://doi.org/10.1136/bmjopen-2016-013293

In the systematic review by Singal et al. (2016), they utilized a registry to identify a mother-baby couplet that met the qualifications for the study. Leveraging the registry allowed for a link to health, education, and social data. The retrospective study qualifications were mom and baby born within a hospital and a diagnosis of a mood disorder at minimum three months before the conception. In addition, the mom must be treated with antidepressant medications that overlap from pre-pregnancy to pregnancy. A validated tool, the Early Development Instrument, was used to assess the development level.

One critique of this article was that while they identified the moms taking antidepressant medications, they could not be certain that they were not using illicit drugs or other psychiatric drugs that could impact the child’s cognitive, physical, and psychological development. Furthermore, the study highlighted that genetics could predispose the psychological component to the child rather than prolonged exposure to antidepressant medications. Determination of treatment with antidepressants must be based on the individual and not on observational studies.