Is Autism in Boys Linked to Prenatal SSRIs?

A population-based study suggests that there may be a link between autism spectrum disorder (ASD) in boys and prenatal exposure to selective serotonin reuptake inhibitors (SSRIs). The researchers caution, however, that interpretation of their findings is complicated by potential recall bias and residual confounding and that maternal depression alone is risky for a fetus.

A total of 966 mother-child pairs from the Childhood Autism Risks from Genetics and the Environment (CHARGE) Study (492 ASD, 154 developmental delays [DD], 320 typical development [TD]) were included in the new analysis, published in Pediatrics. Investigators from Johns Hopkins, the University of Massachusetts, and the University of California, Davis confirmed developmental status using standardized measures and interviewed the biological mothers to determine their prenatal use of SSRIs, mental health history and to gather sociodemographic information.

Prenatal SSRI exposure was nearly three times as likely in boys with ASD than in those with TD (adjusted odds ratio [OD]: 2.91; 95% confidence interval [CI]: 1.07-7.93), with the strongest association with first-trimester exposure (OR: 3.22; 95% CI: 1.17-8.84). SSRI exposure also was higher in boys with DD (OR: 3.39; 95% CI: 0.98-11.75), with the strongest association in the third trimester (OR: 4.98; 95% CI: 1.20-20.62). Prevalence of prenatal SSRI exposure was lowest in children with TD (3.4%) but did not differ significantly from that in children ASD (5.9%) or DD 5.2%).

The authors noted the inconsistency of results from published studies of SSRIs and ASD and that larger samples are needed to replicate their results. “Because maternal depression itself carries risk for the fetus,” they said, “the benefits of prenatal SSRI use should be carefully weighed against potential harms.” 

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