MedicalResearch.com Interview with:
Claudia I. Lugo-Candelas, PhD
Postdoctoral Research Fellow
Columbia University Medical Center/ New York State Psychiatric Institute
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We have seen, in the last decade, an increase in the amount of mothers being prescribed SSRIs during pregnancy. While we know that untreated prenatal maternal depression has adverse consequences for both the mother and child, it’s not really clear what, if any, are the consequences of prenatal SSRI exposure on infant’s brain development. There have been some studies finding increased depression and anxiety in children prenatally exposed to SSRIs, but not all studies find these associations.
We thus looked at 2-4 week old infants’ brains, using neuroimaging. We found increased gray matter volume within the amygdala and insula, and increased white matter connectivity between these two structures in infants prenatally exposed to SSRIs. Of note, the statistical significance and the size of the effects we detected are quite large, even greater than the brain changes that we usually observe in our studies of children and adults with psychiatric disorders. Further, because these structures are involved in emotion processing, and alterations in volume and connectivity are sometimes seen in clinical populations, or in people at risk for anxiety, it important to learn more about what these volume and connectivity differences could mean for these infants.
MedicalResearch.com: What should readers take away from your report?
Response: Whereas our study suggests prenatal SSRI exposure alters fetal brain development, many important questions remain, and more research on the topic is sorely needed. Importantly, we did not examine the long-term effects of the brain changes associated with prenatal exposure to SSRI, so we don’t really know if there are any long-lasting emotional or cognitive consequences associated to these brain differences.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future longitudinal studies that assess both brain structure and function and behavioral and emotional development from infancy to adulthood are needed. Until such studies exist, we won’t be able to provide any concrete guidance to either pregnant women or prescribers. Additionally, we need studies that thoroughly assess if there are any pre-existing differences between mothers who continue taking SSRIs during their pregnancy versus those who don’t. One could imagine that the first group might represent a group of more severely depressed women, which could have important consequences on our studies and findings. Finally, it is important to understand if there are any variables within the infant mother dyad that impact the effect of SSRIs, for example, genetic differences, family history of depression.
MedicalResearch.com: Is there anything else you would like to add?
Response: It is important to note that unfortunately right now, based on our study, we cannot advise mothers and their doctors on whether to start or continue SSRIs through pregnancy. For now, each mother and their team of doctors should discuss the pros and cons of medication, and choose the option that makes the most sense for their particular situation.
Conflict of Interest Disclosures: None reported.
Funding/Support: This study was supported in part by National Institute of Mental Health grants P05-MH090966 (Dr Gingrich) and K01-MH109836 (Dr Cha); Brain & Behavior Research Foundation National Alliance for Research on Schizophrenia and Depression Young Investigator award (Dr Cha); Young Investigator Grant at Korean-American Scientists and Engineers Association (Dr Cha); and the Edwin S Webster Foundation (Dr Posner). Dr Posner has received research support from Shire Pharmaceuticals and Aevi Genomics.
Lugo-Candelas C, Cha J, Hong S, et al. Associations Between Brain Structure and Connectivity in Infants and Exposure to Selective Serotonin Reuptake Inhibitors During Pregnancy. JAMA Pediatr. Published online April 09, 2018. doi:10.1001/jamapediatrics.2017.5227
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