Antidepressant Use During Pregnancy Linked to Increased Risk of Childhood Speech and Language Disorders

Summary: Researchers report a 37% higher risk of speech or language disorders in children born to mothers who purchased SSRI antidepressants at least twice during pregnancy.

Source: Columbia University

New research from Columbia University’s Mailman School of Public Health and Columbia University Medical Center finds that children whose mothers purchased selective serotonin reuptake inhibitor (SSRI) antidepressants at least twice during pregnancy had a 37 percent higher risk of being diagnosed with speech or language disorders than children of mothers with depression or other psychiatric disorders who were not treated with antidepressants. The peer-reviewed results will be published in JAMA Psychiatry.

Study Overview and Key Findings

The researchers analyzed data from Finnish national registries covering 845,345 single, live births between 1996 and 2010. Mothers were grouped according to SSRI purchase and psychiatric diagnosis records: mothers who purchased SSRIs once or more before or during pregnancy (15,596), mothers diagnosed with a psychiatric disorder in the year before or during pregnancy who did not purchase antidepressants (9,537), and mothers without antidepressant purchases or depression-related diagnoses (31,207).

When the team examined exposure intensity by prescription purchases, they found that the association with childhood speech and language disorders was strongest for children whose mothers had purchased SSRIs two or more times during pregnancy. The 37 percent increased risk refers specifically to this group. The association remained statistically significant after additional analyses that accounted for indicators of depression severity.

What Types of Disorders Were Observed?

The speech and language disorders identified in the study included expressive and receptive language disorders and articulation disorders involving sound production. The investigators did not find evidence linking maternal SSRI use to poorer academic performance or to motor disorders in offspring.

Biological Context

SSRIs—including fluoxetine, citalopram, paroxetine, sertraline, fluvoxamine, and escitalopram—cross the placenta and enter fetal circulation. Use of these medications during pregnancy has become more common, making careful study of their potential developmental effects a public health priority.

Strengths and Limitations

The study’s strengths include its very large, population-based birth cohort, prospective prescription purchase records during pregnancy, a comparison group of mothers with diagnosed depression who did not use antidepressants, and a comprehensive national register that allowed adjustment for many known confounders.

However, the authors note important limitations. Prescription purchase does not guarantee that the medication was actually taken, so the exposure measure is imperfect. They were also unable to fully rule out the possibility that greater severity of maternal depression explains part or all of the increased risk observed among mothers who filled more than one SSRI prescription. While supplementary analyses that adjusted for clinical indicators did not materially change the findings, residual confounding by severity of maternal psychiatric illness remains a possibility and warrants further research.

Implications

The results suggest that repeated SSRI purchases during pregnancy are associated with a modestly increased risk of clinically diagnosed speech and language disorders in childhood. Clinicians and pregnant patients should weigh the potential risks and benefits of continuing SSRI treatment during pregnancy, considering the risks of untreated maternal depression as well as possible medication effects on child neurodevelopment. These findings support the need for careful monitoring and further study to better understand causal mechanisms and to guide treatment decisions.

Funding and Author Contributions

Funding: This research was supported by NIH Grants P50MH090966 and 2R01 GM095722-05, the Sackler Foundation of Columbia University, Turku University, the Sigrid Juselius Foundation, the Foundation for Pediatric Research in Finland, and the Finnish Medical Foundation.

Co-authors: David Gyllenberg (Columbia University College of Physicians and Surgeons); Ian W. McKeague (Department of Biostatistics, Columbia University Mailman School of Public Health); Keely Cheslack-Postava (Columbia Department of Psychiatry and New York State Psychiatric Institute); Myrna M. Weissman and Jay A. Gingrich (Columbia Department of Psychiatry, Sackler Institute of Developmental Psychobiology, and New York State Psychiatric Institute); Heli Malm (University of Turku, University of Helsinki and Helsinki University Hospital); Susanna Hinkka-Yli-Salomäki (University of Turku and Turku University Central Hospital); Miia Artama (University of Turku and Helsinki University); Mika Gissler (University of Turku and National Institute for Health and Welfare, Helsinki); and Andre Sourander (Columbia Department of Psychiatry, New York State Psychiatric Institute, University of Turku and Turku University Central Hospital). The authors report no conflicts of interest.

Article submitted by Stephanie Berger on behalf of Columbia University. The study will be published in JAMA Psychiatry.