Review of Risk for Autism Spectrum Disorders According to Period of Prenatal Antidepressant Exposure: Interview with:
Florence Gressier MD PhD

Insermk Department of psychiatry
CHU de Bicêtrem Le Kremlin Bicêtre
France What is the background for this study? What are the main findings?

Response: Results from recent studies have suggested an increased risk for Autism Spectrum Disorders (ASDs) in children exposed to antidepressants in utero.

We performed a systematic review of and a meta-analysis of published studies to assess the association between ASDs and fetal exposure to antidepressants during pregnancy for each trimester of pregnancy and preconception.

Our systematic review and meta-analysis suggests a significant association between increased ASD risk and maternal use of antidepressants during pregnancy; however, it appears to be more consistent during the preconception period than during each trimester. In addition, the association was weaker when controlled for past maternal mental illness. Maternal psychiatric disorders in treatment before pregnancy rather than antenatal exposure to antidepressants could have a major role in the risk for Autism Spectrum Disorders. What should readers take away from your report?

Response: The prevention of depression during pregnancy is an important goal. Previous studies reporting an association between fetal antidepressant exposure and ASDs are not sufficient to warrant a discontinuation or avoidance of prescription of antidepressants during pregnancy. The previous differences reported can come from statistical fluctuations, from different criteria of evaluation and different modelings, among which confounders. Previous researches do not mean that women should stop taking their antidepressants.
Clinicians should always balance the risks of maternal depression against the potential neurodevelopmental risks of antidepressant exposure for the fetus. Each prescription should be evaluated individually. Nevertheless, the risk of untreated depression during pregnancy is considerable. What recommendations do you have for future research as a result of this study?

Response: Future research studies should disentangle the role of the mother’s psychiatric condition and psychotropic drug use in the risk for Autism Spectrum Disorders. They should address confounding factors as an assessment of diagnoses, severity of depression, compliance of treatment, dose of antidepressant, co-medication and substance abuse. Further detailed observational data are required to address these potential confounders. Is there anything else you would like to add?

Response: Depression in pregnancy and following childbirth is common, and is an illness with potentially serious consequences. Special attention to risk of depression is needed during pregnancy for women. Depressive symptoms should be assessed in all women during the perinatal period. Prevention could involve raising awareness and training for all health professionals (psychiatrists, obstetricians, pediatricians, and general practitioners) to detect women at risk for perinatal depression. Each prescription should be evaluated individually. Different treatment approaches may help women with depression in the perinatal period and may include support, psychological and social interventions and, if necessary, for some, antidepressants.

We thank you for your interest in our work.

Disclosures: Dr Falissard has been a consultant or expert and/or has given talks for Eli Lilly, Bristol-Myers Squibb, Servier, Sanofi, GlaxoSmithKline, HRA, Roche, Boehringer Ingelheim, Bayer, Almirall, Allergan, Stallergene, Genzyme, Pierre Fabre, AstraZeneca, Novartis, Janssen, Astellas, Biotronik, Daiichi-Sankyo, Gilead, Merck Sharp & Dohme, and Lundbeck. Dr Gressier has given talks for Lundbeck and Servier and received a grant from Servier for a postdoctoral degree (2011-2012). No other disclosures were reported. Thank you for your contribution to the community.


Antonia Mezzacappa, MD et al. Risk for Autism Spectrum Disorders According to Period of Prenatal Antidepressant Exposure: A Systematic Review and Meta-analysis. JAMA Pediatr., April 2017 DOI: 10.1001/jamapediatrics.2017.0124

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on October 18, 2017 by Marie Benz MD FAAD