SSRI use during pregnancy and risk of ASD or developmental delay in children

Evidence indicates that serotonin is altered in children with an autism spectrum disorder (ASD); however, little is known about the developmental effect of exposure to medications that act on a child's serotonin system in utero. This study provides data about the association of prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) on development. The Childhood Autism Risks from Genetics and the Environment (CHARGE) study was used to examine mother-child pairs for which self-reported maternal medication history was available. The sample comprised 479 children with ASD, 152 with developmental delay (DD), and 358 with typical development (TD). Bivariate logistic regression was used to examine the association between prenatal SSRI exposure and developmental outcomes in children. SSRI exposure was similar in the ASD and DD groups (6.1% and 5.9%), and was lowest in the TD group (3.4%). The crude odds ratio for SSRI exposure was 1.86 (95% CI: 0.93-3.69) comparing ASD to TD and 1.81 (95% CI: 0.75-4.40) comparing DD to TD. Compared to the TD group, the odds of SSRI exposure became increasingly greater from the first to third trimester for both the ASD and DD groups, although some subgroups were small. Odds of exposure did not significantly differ between the ASD and DD groups. The pattern of results was similar when the analysis was restricted to mothers who reported experiencing a mental health disorder prior to her child's birth. The analysis indicates that timing of prenatal exposure to SSRIs should be considered when investigating their affect on development.