Autism Linked to Anti-depressant Use in Pregnancy

There’s a new study out, linking autism to the mother’s anti-depressant use in pregnancy – but what does that mean for doctors and patients?

Brain development in the third trimester may be affected by the mother’s use of anti-depressants, resulting in higher rates of autism, based on a records review conducted by Professor Anick Bérard of the University of Montreal and its affiliated CHU Sainte-Justine children’s hospital.

What’s Safe During Pregnancy?

Although ongoing research has labeled many drugs as being ‘Safe’ during pregnancy, only time will really tell whether a medication causes birth defects, long-term health issues, or complications in brain development, as appears to be a risk in this case.

As Dr. Bérard explains, “I would always be very cautious about saying that anything is ‘safe’ during pregnancy. We have to remember that thalidomide was labeled as ‘safe’ for use during pregnancy.”

Antidepressants, Pregnancy, and Autism: Answers

After reading about this study, many doctors and patients will have questions about the appropriate use of antidepressants during pregnancy, particularly during the last two trimesters. Here are a few answers:

Autism Rates in Boys vs. Girls: Autism occurs at a four-to-one rate of boys versus girls. (There are four boys with autism for every girl with autism.) We asked Dr. Bérard whether antidepressant use during the third trimester of pregnancy increased the risk of autism in girls, or whether the risk factors remained the same. Dr. Bérard told Decoded Science that the same “4:1 boy to girl ratio was seen across groups.”

Impacts on First, Second, Third Trimester: The first trimester is usually identified as the time with the highest risk for the baby – but antidepressant use in the third trimester increases the risk factor when it comes to autism. According to Dr. Bérard, this due to the fact that brain development is most significant during the second and third trimesters.

Antidepressants: Good or Bad? The use of antidepressants, particularly SSRI during the later stages of pregnancy, should be a topic of discussion between a woman and her doctor. As Dr. Bérard explains, “Randomized controlled trials have shown that exercise or psychotherapy are valid treatment options…” when it comes to mildly or moderately depressed pregnant women, so antidepressants aren’t the only option for that population.

Does that mean that pregnant women should never take medication to control their depression? Dr. Bérard is adamant that depression should be treated – but notes that it should be treated using other methods than antidepressants, “…in the majority of cases.”

Selective Serotonin Reuptake Inhibitors (SSRI): SSRI use during the second and third trimesters has the most impact. According to Dr. Bérard, “This makes biological sense because serotonin is essential for brain cell development and inhibition of serotonin reuptake (by SSRI) will perturb brain cell development.”

Conclusions: Dr. Bérard explains that the research illustrates three points:

1. Plan your pregnancy
2. Thoroughly discuss treatment options with your doctor
3. Make an informed decision, understanding the risks and benefits of medication for depression. If you are on an optimal dose of antidepressants prior to becoming pregnant, you would need to increase your dosage to see the same benefits during pregnancy. According to Dr. Bérard, what typically happens instead is that the dosage remains the same (and is thereby ineffective) or it is decreased (also ineffective) – in both cases, the risk remains the same for side effects, but there is no benefit.

Increased Autism Risk

Dr. Bérard tells us, “Using antidepressants, especially SSRI, during the 2nd/3rd trimesters of pregnancy increases the risk of having a child with autism (87% increased risk of autism with any antidepressants; more than doubling the risk with SSRI use specifically) – this risk is above and beyond the risk associated with maternal depression (maternal depression was associated with a 20% increased risk of autism in our study).”

With such a significant increase in risk, is it any wonder that the final recommendation of this researcher is, “… treat depression with non-antidepressant options during gestation.”

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