Summary: Children who were exposed in utero to SSRIs or SNRIs showed a higher likelihood of language and cognitive delays by kindergarten compared with children whose mothers had prenatal depression but did not take these medications.
Source: University of Manitoba
Key finding: A population-based study from the University of Manitoba finds that children of mothers diagnosed with mood or anxiety disorders who took serotonergic antidepressants (SSRIs or SNRIs) during pregnancy had an increased risk of developmental vulnerabilities—particularly in language and cognitive domains—when assessed at kindergarten age, compared with similar children whose mothers did not take these medications.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are among the most commonly prescribed antidepressants in pregnancy. More than one in ten pregnant women receive antidepressant prescriptions, yet relatively little large-scale research has examined how prenatal exposure to these drugs may affect early childhood brain development.
The new study, titled “In Utero Antidepressants and Neurodevelopmental Outcomes in Kindergarteners,” used comprehensive, linkable administrative data housed at the Manitoba Centre for Health Policy (MCHP) to assess neurodevelopment at school entry. It is one of the first population-level investigations to compare kindergarten developmental outcomes among children whose mothers had a prenatal mood or anxiety disorder and either did or did not fill prescriptions for SSRIs or SNRIs during pregnancy.
The research team, led by Deepa Singal (adjunct researcher, MCHP), with Marni Brownell and Dan Chateau, identified more than 3,000 children born between 1996 and 2014 whose mothers had a mood or anxiety disorder around the time of conception. Within that group, mothers were classified as exposed if they filled at least two prescriptions for an SSRI or SNRI during pregnancy and unexposed if they had no dispensations of these drugs in pregnancy.
To evaluate developmental health at kindergarten, the investigators used the Early Development Instrument (EDI), a teacher-completed assessment covering five domains: physical health and well-being; language and cognitive development; social competence; emotional maturity; and communication skills and general knowledge. Children who score below national cutoffs in any domain are considered developmentally vulnerable in that area.
Results show that 21.4% of children whose mothers had SSRI/SNRI dispensations during pregnancy were classified as vulnerable on two or more EDI domains, compared with 16.2% of children whose mothers had a mood or anxiety diagnosis but did not receive these medications. After adjusting for potential confounders, the exposed group had a significantly increased odds of developmental vulnerability in multiple domains. The exposed children also had a higher adjusted risk of being vulnerable specifically in the language and cognitive domain.
Lead author Dr. Deepa Singal emphasizes caution in interpreting the findings. While the results suggest an association between prenatal SSRI/SNRI exposure and a greater likelihood of developmental vulnerability at kindergarten, the authors note that untreated maternal depression also carries risks to both mother and child. Untreated prenatal depression can lead to inadequate prenatal care, poor nutrition or sleep, higher risk of postpartum depression, and greater risk of substance use, all of which can negatively affect child development.
Because both maternal mental health and medication exposure can influence outcomes, the study highlights the need for careful, individualized decision-making between pregnant women and their healthcare providers. The authors recommend that clinicians and patients weigh the potential risks and benefits of antidepressant therapy during pregnancy and consider comprehensive approaches that include non-pharmacologic treatments when appropriate.
The study also underscores the importance of accessible mental health resources for pregnant women. Dr. Singal notes that, particularly during periods of increased stress such as the COVID-19 pandemic, social isolation and economic disruption can elevate anxiety and depression, making clear communication about treatment options and supportive services essential.
Beyond prenatal care, the findings point to the value of early monitoring and intervention for children whose mothers experienced mood or anxiety disorders during pregnancy. Because EDI-measured developmental health at kindergarten is a strong predictor of later academic achievement, identifying and supporting at-risk children early can improve educational and developmental trajectories.
Funding: The research was supported by the Canadian Institutes of Health Research.
About this research
Source: University of Manitoba. Media contacts: Press Office – University of Manitoba. Image source: public domain.
Original research: Deepa Singal, Dan Chateau, Shannon Struck, Janelle Boram Lee, Matthew Dahl, Shelly Derksen, Laurence Y. Katz, Chelsea Ruth, Ana Hanlon-Dearman and Marni Brownell. “In Utero Antidepressants and Neurodevelopmental Outcomes in Kindergarteners.” Pediatrics. DOI: 10.1542/peds.2019-1157. Open access.
Abstract (summary): Using province-wide administrative data, the investigators created a cohort of mother–child dyads born in Manitoba between 1996 and 2014 and restricted the sample to mothers with a mood or anxiety disorder around conception. Exposed children were those whose mothers had at least two SSRI or SNRI dispensations during pregnancy. Among the 3,048 children meeting inclusion criteria with EDI data, 21.43% of exposed children were vulnerable on two or more domains versus 16.16% of unexposed children (adjusted odds ratio 1.43; 95% CI 1.08–1.90). Exposed children also had increased adjusted odds of vulnerability in language and/or cognition (adjusted odds ratio 1.40; 95% CI 1.03–1.90). The authors conclude that prenatal exposure to SSRIs or SNRIs was associated with higher risk of developmental vulnerability at kindergarten, particularly in language and cognitive development, and recommend replication before making definitive clinical recommendations.
Please note: These findings describe an association observed in population data and do not prove causation. Decisions about antidepressant use in pregnancy should be made with a healthcare provider, considering the individual clinical situation and the balance of potential risks and benefits.
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