Many women experience depression during pregnancy, but a significant number fail to receive proper treatment due to concerns about effects on the fetus. In particular, there have been widespread worries that taking antidepressants during pregnancy could increase a child's risk of autism spectrum disorder or attention-deficit hyperactivity disorder (ADHD). However, a recent large-scale study has drawn attention with findings that there is no significant association between taking antidepressants during pregnancy and the risk of autism or ADHD in children. The findings are expected to serve as medical evidence that necessary treatment should not be arbitrarily discontinued simply because a woman is pregnant.
According to a meta-analysis published on the 15th in the international journal "The Lancet Psychiatry," a Hong Kong research team comprehensively analyzed 37 studies including more than 600,000 cases of antidepressant use during pregnancy. The analysis covered approximately 650,000 cases in the antidepressant group and approximately 24 million cases in the non-medicated group. The researchers examined the link between antidepressant use and neurodevelopmental disorders in children while taking into account maternal mental health status, family history, and genetic and environmental factors.
In the initial analysis, antidepressant use during pregnancy appeared to increase a child's ADHD risk by 35% and autism spectrum disorder risk by 69%. However, when the analysis was redone to reflect major confounding factors such as the mother's history of mental illness, most of these associations disappeared. "This is reassuring evidence that commonly used antidepressants do not increase the risk of neurodevelopmental disorders such as autism or ADHD in children," the research team explained.
Notably, the researchers also analyzed data on fathers' antidepressant use during pregnancy. The results showed that paternal antidepressant use was also associated with a 46% increase in children's ADHD risk and a 28% increase in autism spectrum disorder risk. However, medications taken by fathers cannot be directly exposed to the fetus. The researchers interpreted that this result suggests that common factors such as parents' mental health vulnerability, genetic factors, and family environment may be related to a child's neurodevelopmental traits, rather than the effects of the medication itself.
Experts assessed that the study is significant in reducing unnecessary fears surrounding the treatment of depression during pregnancy. "This study is the largest-ever meta-analysis examining the correlation between antidepressant exposure during pregnancy and the risk of neurodevelopmental disorders in children," said Ko Jae-won, a professor of brain sciences at the Daegu Gyeongbuk Institute of Science and Technology (DGIST). "It presents an important turning point that scientifically resolves the vague concerns that have existed until now." He added that "the risk of relapse and potential impairment of fetal development that pregnant women with moderate-to-severe depression face when discontinuing treatment may be greater than the risks of taking medication."
Oh Kyung-soo, a professor at Chung-Ang University's College of Pharmacy, also explained that "no significant association was confirmed between taking antidepressants during pregnancy and overall neurodevelopmental disorders in newborns." However, he pointed out that a statistical association with autism spectrum disorder was observed for some older tricyclic antidepressants such as amitriptyline and nortriptyline. "These drugs tend to be prescribed mainly to patients with treatment-resistant severe depression, so the link is more likely to be related to the mother's severe depressive condition rather than the medication itself," Oh said.
There are also warnings that leaving depression untreated during pregnancy can lead to even greater risks. Experts explain that untreated depression during pregnancy can increase the risk of premature birth and low birth weight, as well as raise the risks of postpartum depression and maternal suicide, and lead to problems in mother-infant attachment. The Royal College of Obstetricians and Gynaecologists in the United Kingdom also assessed the study as "providing evidence-based, reassuring evidence that the use of antidepressants during pregnancy is not associated with ADHD or autism in children."
However, the researchers and experts emphasized that the findings do not mean that the same approach to medication is recommended for all pregnant women. They explained that decisions on whether to continue treatment should be made after consulting with medical professionals, taking into account the severity of depression, the type of medication, past treatment history, and gestational age. There are also concerns that the study has the limitation that much of the overall data is centered on white populations, indicating a need for follow-up research targeting Asians, including Koreans.
