Prenatal antidepressant exposure is associated with risk for attention-deficit hyperactivity disorder but not autism spectrum disorder in a large health system

Previous studies suggested that risk for Autism Spectrum Disorder (ASD)
may be increased in children exposed to antidepressants during the
prenatal period. The disease specificity of this risk has not been
addressed and the possibility of confounding has not been excluded.
Children with ASD or attention-deficit hyperactivity disorder (ADHD)
delivered in a large New England health-care system were identified from
electronic health records (EHR), and each diagnostic group was matched
1:3 with children without ASD or ADHD. All children were linked with
maternal health data using birth certificates and EHRs to determine
prenatal medication exposures. Multiple logistic regression was used to
examine association between prenatal antidepressant exposures and ASD or
ADHD risk. A total of 1377 children diagnosed with ASD and 2243 with
ADHD were matched with healthy controls. In models adjusted for
sociodemographic features, antidepressant exposure prior to and during
pregnancy was associated with ASD risk, but risk associated with
exposure during pregnancy was no longer significant after controlling
for maternal major depression (odds ratio (OR) 1.10 (0.70–1.70)).
Conversely, antidepressant exposure during but not prior to pregnancy
was associated with ADHD risk, even after adjustment for maternal
depression (OR 1.81 (1.22–2.70)). These results suggest that the risk of
autism observed with prenatal antidepressant exposure is likely
confounded by severity of maternal illness, but further indicate that
such exposure may still be associated with ADHD risk. This risk, modest
in absolute terms, may still be a result of residual confounding and
must be balanced against the substantial consequences of untreated
maternal depression.

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