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Link between prenatal antidepressant use, ADHD risk may be overestimated

Prenatal antidepressant use and risk for ADHD may be partially due to confounding by indication of antidepressants, according to recent findings.

“Recent studies have suggested a potential association between maternal prenatal use of antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs), and the risk of ADHD in children,” Kenneth K. C. Man, BSc, MPH, of the University of Hong Kong, and colleagues wrote. “A systematic literature search identified six observational studies, including three cohort studies and three case-control studies, which investigated the association between antidepressant use in pregnancy and ADHD in children, with the study populations from Scandinavian countries or North America. However, findings were inconsistent.”

To determine associations between prenatal antidepressant use and risk for ADHD in offspring, researchers conducted a population-based cohort study of 190,618 children born in Hong Kong public hospitals between January 2001 and December 2009. Follow-up was conducted until December 2015.

Overall, 1,252 children had a mother who use prenatal antidepressants.

Three percent of the cohort was diagnosed with ADHD or received treatment for ADHD.

Maternal antidepressant use during pregnancy had a crude hazard ratio of 2.26, compared with nonuse (P < .01).

When adjusting for potential confounders, including maternal psychiatric disorders and use of other psychiatric drugs, the adjusted hazard ratio decreased to 1.39 (95% CI, 1.07-1.82; P = .01).

Researchers found similar results when comparing children of mothers who had used antidepressants before pregnancy with those who never used antidepressants (HR = 1.76; 95% CI, 1.36-2.3; P < .01).

Children with mothers with psychiatric disorders had higher risk for ADHD, even if mothers had never used antidepressants (HR = 1.84; 95% CI, 1.54-2.18; P < .01).

Results from sensitivity analyses were similar, according to researchers.

Sibling matched analysis did not indicate a significant difference in ADHD risk between siblings exposed to antidepressants vs. those not exposed during gestation (HR = 0.54; 95% CI, 0.17-1.74).

“Previous reports might have overestimated the association between gestational use of antidepressants and ADHD in offspring because they have failed to control for shared family factors,” the researchers wrote. “Although we cannot completely discount the possibility that gestational use of antidepressants is a causal factor, our findings raise the possibility that confounding by indication might at least partially explain the observed association.” – by Amanda Oldt

Disclosure: Man reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.