Prenatal antidepressant exposure may increase risk of poor motor development

Originally Published By 2 Minute Medicine®. Reused on Clinical Advisor with permission.
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A meta-analysis of 18 studies examining the association of prenatal antidepressant exposure with motor development in children showed a small overall effect of worse motor development outcomes among children exposed to antidepressants in pregnancy.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Antidepressants are among the most commonly prescribed medications in the United States, and their use is rising in all populations, but particularly in pregnant women. Antidepressant exposure in utero, while considered mostly safe, has been associated with subtle effects in offspring, with questions of associated poorer neurodevelopmental outcomes. Many studies have examined these questions and, in this study, the authors conducted a systematic review and meta-analysis of studies that examined the associations of prenatal SSRI exposure on offspring motor development outcomes. The overall trend found by the authors was a small significant association of worse motor development outcomes among children exposed to antidepressants during pregnancy. While this meta-analysis combined data over 18 studies, providing excellent evidence, it is limited by the heterogeneity of those studies in their methodology and measurement of motor impairment. Overall, these findings provide evidence of population-level subtle impacts of antidepressant exposure in pregnancy on motor outcomes of offspring.

Click to read the study, published today, in Pediatrics

Relevant Reading: Associations Between Brain Structure and Connectivity in Infants and Exposure to Selective Serotonin Reuptake Inhibitors During Pregnancy.

In-Depth [systematic review and meta-analysis]: In this study, the authors referenced multiple databases and included 24 studies for systematic review. Of those, 18 studies were included for meta-analysis. Using an inverse variance method, the overall pooled effect size for poorer motor outcomes after in utero antidepressant exposure was 0.22 (95% CI: 0.07 – 0.37). The heterogeneity measure of the total pooled data was significant (i2 = 56.6, P= 0.002), with the type of data collected in each study driving this heterogeneity. Notably, when stratifying studies by their outcome measure, only including studies that used standardized methods of assessing motor development, rather than population studies using clinician or parent report, the overall association was ameliorated, and non-significant (effect size = 0.10, 95%CI -0.05 – 0.24). Finally, a funnel plot of the studies included showed no gross deviations from an expected pattern, suggesting no publication selection bias.

Image: PD

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