Do antidepressants in pregnancy raise kids’ ADHD risk?

(Reuters Health) - Women with depression may be more likely than other mothers to have children with attention-deficit/hyperactivity disorder (ADHD) even if they don’t take antidepressants during pregnancy, a recent study suggests.

The results indicate that at least part of the link previously seen between kids’ exposure to antidepressants during pregnancy and their risk of developing ADHD may be explained by “family factors” such as maternal depression, rather than the drugs themselves, the study authors write in The BMJ.

When the researchers compared the children of women with psychiatric disorders who had either taken antidepressants during pregnancy or only before pregnancy, they found the ADHD risk among their children was similar. This was also true for siblings with the same mother but different exposures to antidepressants during pregnancy.

“Pregnant women should not stop treatment because of concerns of ADHD in their children in the future,” senior study author Ian C.K. Wong, of the school of pharmacy at University College London said by email.

In the study of 190,618 kids born in Hong Kong from 2001 to 2009, just 3 percent of the children were diagnosed with ADHD or treated for the condition after an average follow-up of more than nine years.

The type of antidepressant might matter. Researchers didn’t find a meaningful association between children’s ADHD and their mother’s use during pregnancy of a family of drugs known as selective serotonin reuptake inhibitors (SSRIs) that includes Prozac, Zoloft and Celexa, according to the report in The BMJ.

Women who took other types of antidepressants while pregnant were 59 percent more likely to have kids with ADHD than women who didn’t use any antidepressants, however. This might be because women with milder depression typically get SSRIs first, and only try other drugs when they have more severe psychiatric problems that aren’t helped by SSRIs, the authors note.

Even when women never used antidepressants, mothers with psychiatric disorders were 84 percent more likely to have kids with ADHD than mothers without mental health problems, the study also found.

One limitation of the study is that it only included births at public hospitals, the authors note, but this is where most specialist care for kids with brain development issues is provided in Hong Kong. Researchers also used prescription records to assess whether women took antidepressants, which don’t always reflect the drugs people actually take.

Four of the study authors report past grants or consulting work for companies that make antidepressants, and one is an employee of Janssen Research and Development, LLC, a Johnson and Johnson division with an antidepressant under development.

Left untreated, depression during pregnancy is associated with underweight babies who are more likely to wind up in neonatal intensive care, previous research has found. Pregnant women with uncontrolled depression may not eat well or keep up with prenatal visits, and, in the most severe cases they may be at increased risk for suicide.

Like many drugs, antidepressants fall into a gray area during pregnancy, with insufficient evidence to definitively prove the harms or benefits. Often, doctors may only consider these drugs for women with more severe depression.

Because some uncertainties about antidepressant use in pregnancy remain, it still makes sense to reserve them for women with serious psychiatric symptoms, Wong said.

“Pregnant women with mild depression may benefit from non-drug treatment such as psychotherapy,” Wong added.

The study findings aren’t surprising, however, and should reassure women who do need to take antidepressants during pregnancy, said Dr. Roy Perlis, a psychiatry researcher at Harvard Medical School in Boston who wasn’t involved in the study.

“No one wants to take medications they don’t need,” Perlis added. “But people sometimes forget that depression itself carries risk.”

SOURCE: The BMJ, online May 31, 2017.