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Prenatal SSRI exposure linked to fetal brain development
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Selective serotonin reuptake inhibitor use during pregnancy may be associated with fetal brain development, particularly in regions critical to emotional processing, according to study results recently published in JAMA Pediatrics.
“The prescription of selective serotonin reuptake inhibitor (SSRI) medication for pregnant women has accelerated over the past 30 years,” Claudia Lugo-Candelas, PhD, of the department of psychiatry, Columbia University Medical center and New York State Psychiatric Institute, New York, and colleagues wrote. “To some extent, this rise may be attributable to increased awareness of the detrimental effects of untreated prenatal maternal depression (PMD) on women and children, along with early studies failing to document immediate effects of SSRI exposure in offspring (although later rodent studies document postpubertal alterations). However, little is known about the association between prenatal SSR exposure and human fetal neurodevelopment.”
The researchers conducted a cohort study at Columbia University Medical Center and New York State Psychiatric Institute.
Structural MRI with voxel-based morphometry was used to estimate gray matter volume and diffusion MRI with probabilistic tractography was used to estimate white mater structural connectivity, the study’s main outcome measures.
Pregnant women, aged 18 to 45 years, were recruited, with the study sample including 98 mother and infant dyads (32% white, 27% Hispanic, 27% black and 15% other; 53% girls). At the time of MRI scan, the mean age of the infants was 3.43 weeks.
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MRI data were collected from 98 infants. including 16 with in utero SSRI exposure, 21 with in utero untreated maternal depression exposure and 61 healthy controls without exposure. There was not a significant difference in infant gestational age at birth, sex and birth weight (all P > .05; analysis of variance). Data were collected from Jan. 6, 2011, to Oct. 26, 2016.
The SSRI-exposed infants had significant gray matter volume expansion in the right amygdala and right insula (Cohen d = 0.65; 95% CI, 0.06-1.23; Cohen d = 0.86; 95% CI, 0.26-1.14, respectively) in infants exposed to SSRI when compared with the healthy control cohort and infants exposed to untreated maternal depression, according to voxel-based morphometry. The right amygdala and right insula had a significant increase in connectivity with a large effect size in the SSRI cohort when compared with the healthy control and untreated depression cohorts when using connection-level analysis of white matter structural connectivity (Cohen d = 0.99; 95% CI, 0.40-1.57).
“Use of SSRIs during pregnancy has increased during recent decades, yet their association with fetal neurodevelopment continues to be a topic of considerable debate,” the researchers concluded. “Because untreated PMD poses risk to both the infant and the mother, the decision to initiate, continue or suspend SSRI treatment remains a clinical dilemma.”
“Further study is required to better elucidate the effects of gestational SSRI exposure on fetal brain development and later life susceptibility to depressive, cognitive and motor abnormalities. Such information may eventually allow more informed clinical decisions about how to best treat psychiatric disorders during pregnancy for the benefit of both mother and fetus.” – by Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.
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