2013 Apr 19;346:f2059. doi: 10.1136/bmj.f2059.
depression, maternal antidepressant use during pregnancy, and risk of
autism spectrum disorders: population based case-control study.
for Mental Health, Addiction and Suicide Research, School of Social and
Community Medicine, University of Bristol, Bristol BS8 2BN, UK.
study the association between parental depression and maternal
antidepressant use during pregnancy with autism spectrum disorders in
Population based nested case-control study.
Stockholm County, Sweden, 2001-07.
cases of autism spectrum disorder (1828 with and 2601 without
intellectual disability) and 43 277 age and sex matched controls in the
full sample (1679 cases of autism spectrum disorder and 16 845 controls
with data on maternal antidepressant use nested within a cohort
(n=589 114) of young people aged 0-17 years.
MAIN OUTCOME MEASURE:
diagnosis of autism spectrum disorder, with or without intellectual
disability. EXPOSURES: Parental depression and other characteristics
prospectively recorded in administrative registers before the birth of
the child. Maternal antidepressant use, recorded at the first antenatal
interview, was available for children born from 1995 onwards.
history of maternal (adjusted odds ratio 1.49, 95% confidence interval
1.08 to 2.08) but not paternal depression was associated with an
increased risk of autism spectrum disorders in offspring. In the
subsample with available data on drugs, this association was confined to
women reporting antidepressant use during pregnancy (3.34, 1.50 to
7.47, P=0.003), irrespective of whether selective serotonin reuptake
inhibitors (SSRIs) or non-selective monoamine reuptake inhibitors were
reported. All associations were higher in cases of autism without
intellectual disability, there being no evidence of an increased risk of
autism with intellectual disability. Assuming an unconfounded, causal
association, antidepressant use during pregnancy explained 0.6% of the
cases of autism spectrum disorder.
exposure to both SSRIs and non-selective monoamine reuptake inhibitors
(tricyclic antidepressants) was associated with an increased risk of
autism spectrum disorders, particularly without intellectual disability.
Whether this association is causal or reflects the risk of autism with
severe depression during pregnancy requires further research. However,
assuming causality, antidepressant use during pregnancy is unlikely to
have contributed significantly towards the dramatic increase in observed
prevalence of autism spectrum disorders as it explained less than 1% of