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Antidepressant use during pregnancy and psychiatric disorders in children

Results of a Danish nationwide register-based cohort study

Antidepressant use during pregnancy and psychiatric disorders in children

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In utero exposure to antidepressants is associated with increased risk of psychiatric disorders, a population based cohort study has found.

However, findings suggest that focusing on a single psychiatric disorder among offspring in studies of in utero antidepressant exposure may be too restrictive.

The association may be attributable to the severity of underlying maternal disorders combined with antidepressant exposure in utero.

The study consisted of 905,383 liveborn singletons born during 1998-2012 in Denmark who were followed from birth until July 2014, death, emigration or date of first psychiatric diagnosis, whichever came first.

The children were followed for a maximum of 16.5 years and contributed 8.1×106 person years at risk.

The children were categorised into four groups according to maternal antidepressant use within two years before and during pregnancy: unexposed, antidepressant discontinuation (use before but not during pregnancy), antidepressant continuation (use both before and during pregnancy) and new user (use only during pregnancy).

The first psychiatric diagnosis in children was defined as first day of inpatient or outpatient treatment for psychiatric disorders. Hazard ratios of psychiatric disorders were estimated using Cox regression models.

Overall, psychiatric disorders were diagnosed in 32,400 children. The adjusted 15-year cumulative incidence of psychiatric disorders was 8.0% (95% confidence interval 7.9% to 8.2%) in the unexposed group, 11.5% (10.3% to 12.9%) in the antidepressant discontinuation group, 13.6% (11.3% to 16.3%) in the continuation group and 14.5% (10.5% to 19.8%) in the new user group.

The antidepressant continuation group had an increased risk of psychiatric disorders (hazard ratio 1.27, 1.17 to 1.38), compared with the discontinuation group.

Liu X, Agerbo E, Ingstrup KG et al (2017) Antidepressant use during pregnancy and psychiatric disorders in offspring: Danish nationwide register based cohort study. BMJ. 358, j3668.

Compiled by Kimberley Hackett, assistant editor Nursing Children and Young People

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