There is no clear link between the use of common antidepressants in pregnancy and autism or ADHD in children, finds the most comprehensive study to date, published in Lancet Psychiatry. 

The meta-analysis of 37 studies covering more than half a million pregnancies found that while some studies showed a small increase in the risk of autism or ADHD in the children of women who used antidepressants while pregnant, this was not caused by the medication itself. Instead, the findings suggest the link is more likely explained by underlying parental mental health conditions and genetic factors.

The All Ireland Science Media Centre asked experts to comment.  

Dr Jane English, Principal Investigator, INFANT Research Centre, University College Cork, comments: 

“A new study by Chan and colleagues offers reassuring evidence regarding antidepressant treatment during pregnancy and its link to Autism and ADHD in children. After carefully reviewing data from 37 studies, the researchers found very little evidence to suggest that antidepressants while pregnant increases the likelihood of a child being neurodivergent. When they accounted for other influencing factors, such as the mother’s mental health condition, the evidence for a direct cause‑and‑effect relationship was low.

“These findings support what experts already agree on: Autism and ADHD are highly heritable, passed down through families mainly by complex genetic influences.

“A key strength of the study is that it also looked at fathers’ antidepressant use. If both parents have a genetic predisposition or mental health condition, there may be a cumulative effect, that could make neurodivergence more likely in their child.

“The authors conclude that pregnant women with moderate to severe depression should continue antidepressant treatment. The main message: supporting the mental health of both parents is important not only for their own wellbeing but for their child’s long‑term brain development.’

Declaration of interest: No conflicts of interest to declare

Professor Brian Cleary, Irish Medicines in Pregnancy Service, Rotunda Hospital & RCSI, comments: 

“This is an important study that reiterates findings of recent well-designed studies assessing the association between antidepressant exposure in pregnancy and neurodevelopmental outcomes in children.

“The authors pooled the results of studies involving nearly 650,000 pregnancies with prenatal antidepressant use. They found that associations between antidepressant exposure and outcomes such as ADHD and autism spectrum disorder disappeared or diminished when factors such as maternal mental health disorders and familial/genetic characteristics were considered. Risks were also seen with maternal use of antidepressants before pregnancy and paternal use of antidepressants during pregnancy, suggesting that factors other than antidepressant use may explain the occurrence of ADHD and autism.

“The authors concluded that antidepressant treatment should be continued for pregnant women with moderate-to-severe depression and that optimal maternal and paternal perinatal mental health care was important for the child’s long-term development.

“When combined with what we know from individual studies, this study indicates that there is no robust support for an association between prenatal antidepressant use and increased risk of ADHD and autism.

“Stopping antidepressants during or prior to pregnancy may lead to worse maternal depression, which is a known risk factor for serious adverse pregnancy outcomes. This information should be interpreted in the context of the serious potential impact of maternal mental health disorders during and after pregnancy.

“Recent analyses of maternal deaths in the UK and Ireland indicate that suicide is the leading cause of maternal death occurring between six weeks and one year after the end of pregnancy, while deaths from psychiatric causes accounted for 33% of maternal deaths overall.”

Declaration of interest: The author declares no competing interests