CNS Aspects of Prenatal Drug Exposure

Abstract

Studies of the effects of prenatal exposure (to drugs or environmental factors) on postnatal brain morphology and function have an important role in assessing adverse effects of prenatal administration of corticosteroids in obstetrics, in studying the impairment of the offspring due to maternal drug abuse, as well as in studies of the influence of other environmental factors (such as toxins or stress). Timing, duration, and dose of the prenatal exposure play a significant role in the postnatal expression of the impact. However, data interpretation may be complicated by additional factors. As mixed litters of prenatally exposed subjects are evaluated, significant differences between males and females may occur. Additionally in females, cyclical changes in ovarian steroids may interfere with the effects of prenatal impact. Developmental differences may be also present, and data from infant, juvenile, prepubertal, and adult individuals cannot be simply compared. Finally, prenatal treatment is a stressful event and may present itself as prenatal stress, misguiding the interpretation. Postnatal environmental factors in raising the offspring, such as housing, maternal care, light-dark cycle, and weaning age can also change the data in such a way, which makes comparisons between different research laboratories impossible.

Serotonin Reuptake Inhibitor Use During Pregnancy—Reply

“…The media have not made our task easy, with sensational headlines such as, "Maternal SSRI Use Linked to Speech, Language Disorders" 2 and "Study Links Antidepressants in Pregnancy With Language Disorders." 3 Despite in-herent study design difficulties 4 and small absolute differences, the authors claimed that "we have provided novel evidence of an association between speech/language disorders in offspring and [serotonin reuptake inhibitor] use during pregnancy." 1 At the UCLA Women's Life Center, we value transparency and share new data with our patients.…”

“…1 Regarding the specificity of our association between maternal SSRIs and speech and language dysfunction, it is well known that in-utero insults to central nervous system-active agents can selectively impair vulnerable neural circuits and functions while sparing others. 3 Alan S. Brown, MD, MPH Heli Malm, MD, PhD Andre Sourander, MD, PhD…”

“…Regarding multiple comparisons, the observed P value for speech/language disorders for offspring of mothers who filled more than 1 prescription was .004, which remained statistically significant following Bonferroni correction for the 6 comparisons of the SSRI vs the psychiatric disorders, vs no medication group in Table 3 ( P = .008) . Regarding the specificity of our association between maternal SSRIs and speech and language dysfunction, it is well known that in-utero insults to central nervous system–active agents can selectively impair vulnerable neural circuits and functions while sparing others …”