Prenatal antidepressant exposure and the risk of autism spectrum disorders in children. Are we looking at the fall of Gods?

- Six out of the eight articles reviewed here (including case-control and prospective studies) confirm an association between SSRI exposure through placenta and an increase in the risk of ASDs in children.
- Another study failed to find an association between antenatal SSRI exposure and ASDs, but suggested that maternal use of such antidepressants during pregnancy may increase the risk of ADHD.
- Two studies found no association between antenatal exposure to other classes of antidepressants (such as TCAs and DAAs) and increased rates of ASDs in children.
- The relationship between TCA exposure and ASDs was just noted in one study. Until now, this finding remains non-replicated.
- It is possible that classes of antidepressants others than SSRIs should be considered the “new” gold standard for treating women who develop severe depressive symptoms during pregnancy.

Recent information suggests that antenatal exposure to psychotropics may impair child neurodevelopment. Thus, aim of this review is to examine systematically available literature investigating potential associations between prenatal use of selective serotonin reuptake inhibitors (SSRIs) and the risk of autism spectrum disorders (ASDs).MethodsMedical literature published in English since 1988 identified using MEDLINE/PubMed, EMBASE, SCOPUS, and The Cochrane Library. Search terms: antidepressants, autism (spectrum disorders), childhood, children, neurodevelopment, pregnancy, SSRIs. Searches were updated until March 5, 2015.ResultsSix out of eight reviewed articles confirm an association between antenatal SSRI exposure and an increased risk of ASDs in children. However, the epidemiologic evidence on the link between prenatal SSRI exposure and ASD risk must still be cautiously interpreted, because of potential biases of analyzed research.LimitationsMain limitations of reviewed studies include: lack of directly validated clinical evaluation, impossibility to identify women who really took the prescribed medications during pregnancy, no assessment of severity and course of symptoms in relation to the pregnancy, lack of information about unhealthy prenatal lifestyle behaviors.ConclusionsDespite such limitations, available data show that some signal exists suggesting that antenatal exposure to SSRIs may increase the risk of ASDs. Thus, there is an urgent need for further, large, well-designed research finalized to definitively assess the existence and the magnitude of this severe risk, thus confirming or denying that we are truly looking at “the fall of Gods”, since for many years SSRIs have been considered the first-choice agents for treating antenatal depression (Gentile, 2014; Gentile, 2011a; Gentile, 2005).