Association of Maternal Antidepressant Prescription During Pregnancy With Standardized Test Scores of Danish School-aged Children

Christensen, Jakob; Trabjerg, Betina B.; Sun, Yuelian; Dreier, Julie Werenberg

doi:10.1001/jama.2021.17380

Cited by 21 publications

(32 citation statements)

References 33 publications

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“…Fifth, potential mediators, such as psychotropic and antiepileptic prescriptions, may be misclassified as covariates. However, here, we used the presence of these prescriptions as proxies for comorbid conditions, as is common in pharmaco‐epidemiological research 44,45 46 .…”

Section: Discussionmentioning

confidence: 99%

“…However, here, we used the presence of these prescriptions as proxies for comorbid conditions, as is common in pharmaco-epidemiological research. 44,45 Moreover, we may be underestimating the effect of second and third trimester exposure on preterm birth because of immortal time bias, i.e., the error in estimating the association between the exposure and the outcome that results from the exclusion of time intervals. 46 However, it is important to note that 20,259 (94.7%) of children in our study were exposed to antidepressants in the first trimester.…”

Section: Strengths and Limitations Of Studymentioning

confidence: 99%

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Antidepressant use during pregnancy and risk of adverse neonatal outcomes: A comprehensive investigation of previously identified associations

Rommel

Momen

Molenaar

et al. 2022

Acta Psychiatr Scand

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Objective Prenatal antidepressant use is widespread. Observational studies have investigated the neonatal effects of prenatal antidepressant exposure with inconclusive results. We aimed to comprehensively investigate the associations between prenatal antidepressant exposure and the most commonly studied adverse neonatal outcomes: preterm birth, birthweight, poor neonatal adaptation, persistent pulmonary hypertension of the neonate (PPHN), neonatal admission and congenital malformations. Methods We included 45,590 singletons (born 1997‐2015) whose mothers used antidepressants within one year before pregnancy. Children were categorised into two groups: continuation (antidepressant use before and during pregnancy) or discontinuation (antidepressant use before but not during pregnancy). We applied random‐effects logistic and linear regressions, adjusting for covariates. Results After adjusting for confounders, prenatal antidepressant exposure was associated with a 2.3 day (95% CI −2.9; −2.0) decrease in gestational age and a 51 g (95% CI −62g; −41 g) decrease in birthweight. The continuation group was at increased risk for moderate‐to‐late preterm birth (32–37 weeks) (aOR = 1.43; 95%CI 1.33; 1.55), moderately low birthweight (1500–2499 g) (aOR = 1.28; 95%CI 1.17; 1.41), postnatal adaptation syndrome (aOR = 2.59; 95%CI 1.87; 3.59) and neonatal admission (aOR = 1.52; 95%CI 1.44; 1.60) compared to the discontinuation group. Conclusion Prenatal antidepressant exposure was associated with small decreases in gestational age and birthweight, as well as higher risk for moderate‐to‐late preterm birth, moderately low birthweight, neonatal admission and postnatal adaptation syndrome. No differences in risk were found for PPHN, or congenital malformations. The causality of the observed associations cannot be established due to the potential for unmeasured residual confounding linked to the underlying disease.

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Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitations Of Studymentioning

confidence: 99%

Antidepressant use during pregnancy and risk of adverse neonatal outcomes: A comprehensive investigation of previously identified associations

Rommel

Momen

Molenaar

et al. 2022

Acta Psychiatr Scand

View full text Add to dashboard Cite

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“…9 10 Even though multiple studies have shown that antidepressants are not major teratogens, [11][12][13][14] findings remain inconsistent about the risk of longer-term neurodevelopmental outcomes in children, for example, attention-deficit/hyperactivity disorders (ADHD), autism spectrum disorder or scholastic skills. 15 16 Current data about the reproductive safety of antipsychotics and benzodiazepines are limited, [17][18][19] while the short-term and longterm risk posed by the antiseizure drug valproate is now well acknowledged. 20 21 In women with a perinatal mental illness, elevated risk perception of adverse outcomes in offspring due to psychotropic medication exposure often affects the decision-making regarding their treatment.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…The intraclass correlation was below 0.05 in all models, indicating that similarity was low within regions. All statistical analyses were conducted using STATA MP V. 16.…”

Section: Association Analysesmentioning

confidence: 99%

Perceived risk of neurodevelopmental outcomes in offspring related to psychotropic and mental illness exposures in pregnancy and breastfeeding: a cross-sectional survey of women with past or current mental illness

et al. 2022

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ObjectivesTo investigate the perceived risk of psychotropic and mental illness exposures (1) during pregnancy or (2) while breastfeeding on offspring neurodevelopment, and factors associated with this perception in women with past/current mental illness.DesignCross-sectional, web-based study.SettingNationwide in Norway, June 2020–June 2021.ParticipantsWomen aged 18–55 years who were pregnant, recent mothers or planning a pregnancy, and had been offered antidepressants in the last 5 years.Primary and secondary outcome measuresPerceived risk of prenatal and breastmilk exposure to psychotropic medications and maternal mental illness on offspring neurodevelopmental outcomes.ResultsWe included 448 women: 234 pregnant, 146 mothers and 68 planning a pregnancy. On a 0–10 scale, women perceived antidepressants as least harmful both (1) in pregnancy (mean score 4.2, 95% CI 3.6 to 4.8) and (2) while breastfeeding (mean score 3.8, 95% CI 3.3 to 4.4), relative to antipsychotics, anxiety/sleeping medication or antiepileptics (mean score range: 6.3–6.5 during pregnancy, 5.5–6.2 while breastfeeding). Many participants were unfamiliar with psychotropics other than antidepressants. The perceived risk of mental illness exposure exceeded that of antidepressants (mean score range 5.6–5.9) in both exposure periods. Using general linear models, factors associated with greater antidepressant risk perception in both exposure periods included having lower education, non-Norwegian native language, and employment status (range mean score difference (β): 2.07–6.07). For pregnant women and mothers, there was an inverse association between perceived risk and the perceived antidepressant effectiveness in both exposure periods (range of β: −0.18 to –0.25).ConclusionsIn women with past/current mental illness, the perceived risk of antidepressant exposure on child neurodevelopment was lower than that for maternal mental illness. Other psychotropic medications were perceived as more harmful. As medication risk perception influences the decision-making regarding treatment of mental illness, pre- and pregnancy counselling should target women with characteristics associated with higher perceived risk.

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“…Scholastic skills are important indicators of cognitive function, but they are infrequently assessed in perinatal pharmacoepidemiologic studies. 14 , 15 , 16 Scholastic skills, including reading and mathematics abilities, depend on cognitive processes related to executive function and working memory. 17 Thus, scholastic skills can estimate future academic achievement, career aptitudes, and socioeconomic status.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Prenatal Exposure to Opioid Analgesics and Scholastic Skills in Children in Fifth Grade in Norway

et al. 2022

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Association of Maternal Antidepressant Prescription During Pregnancy With Standardized Test Scores of Danish School-aged Children

Cited by 21 publications

References 33 publications

Antidepressant use during pregnancy and risk of adverse neonatal outcomes: A comprehensive investigation of previously identified associations

Antidepressant use during pregnancy and risk of adverse neonatal outcomes: A comprehensive investigation of previously identified associations

Perceived risk of neurodevelopmental outcomes in offspring related to psychotropic and mental illness exposures in pregnancy and breastfeeding: a cross-sectional survey of women with past or current mental illness

Analysis of Prenatal Exposure to Opioid Analgesics and Scholastic Skills in Children in Fifth Grade in Norway

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