Kaiser Permanente analysis does find more autism among children of women with psychiatric conditions
By Jan Greene
Mothers with psychiatric conditions such as depression and anxiety were more likely to have a child with autism than mothers without such conditions, new research led by Kaiser Permanente investigators finds. But the analysis found no association between use of common antidepressants by pregnant women and likelihood of autism in their children.
The study, published in the journal Biological Psychiatry, confirms previous research that suggests SSRI antidepressants used before and during pregnancy are not associated with increased risk of autism and other neurodevelopmental disorders in children.
“This is good news for women managing psychiatric disorders such as depression and anxiety while pregnant,” said lead author Jennifer Ames, PhD, a staff scientist at the Kaiser Permanente Division of Research. “It is consistent with a growing body of research that is trying to better disentangle the separate relationships of SSRI treatment and maternal psychiatric indications with child neurodevelopment.”
While this study supported previous findings, Ames said it has unique strengths, such as including a large and demographically diverse group of mothers and children, analysis of specific subgroups of children with autism spectrum disorder and developmental disorders, and examination of multiple psychiatric disorders of mothers.
The authors studied data from nearly 5,000 children who are part of the Study to Explore Early Development (SEED), a large, geographically and demographically diverse sample of U.S. mothers and children, funded by the Centers for Disease Control and Prevention (CDC). The participants were in 6 states and included a group at Kaiser Permanente Northern California.
The case-control study compared 1,367 children with autism spectrum disorder, 1,750 children with other neurodevelopmental disorders, and 1,671 children in a control group without such disorders. They then examined the mothers’ medical histories for any psychiatric diagnoses and treatment.
They found mothers with psychiatric conditions during pregnancy were 1.6 times to 2 times more likely to have a child with autism or another neurodevelopmental disorder than mothers without psychiatric conditions. The most common psychiatric conditions in the study were depression and anxiety.
This connection has been found in a number of other studies and could be related to a genetic overlap between various psychiatric conditions and autism spectrum disorder, the authors said.
“There is a common set of genes shared among several neuropsychiatric conditions so it is important to examine both the maternal and child genetic contributions to this association,” said study senior author Lisa Croen, PhD, senior research scientist with the Division of Research and director of its Autism Research Program.
When the investigators compared mothers with psychiatric conditions who did use SSRI antidepressants during pregnancy to those who did not, they found no increased likelihood of a child with autism or other neurodevelopmental disorders.
“Whether to continue SSRI medication during pregnancy includes careful weighing of the potential risks of medication to the developing fetus versus risks to mother of untreated depression or anxiety,” said study co-author Christopher L. Eaton, MD, a psychiatrist with The Permanente Medical Group in San Francisco. He noted that despite “an abundance of reproductive safety data” about SSRIs there remains lingering concern about a link to autism. “This important study goes a long way in helping to clarify that question, and thereby does a great service to the patients and their physicians who face these difficult decisions.”
The study was funded by the CDC and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Additional co-authors were Laura A. Shieve, PhD, of the CDC; Christine Ladd-Acosta, PhD, M. Daniele Fallin, PhD, and Li-Ching Lee, PhD, Ellen Howerton of the Johns Hopkins Bloomberg School of Public Health; Yinge Qian, MS, of the Kaiser Permanente Division of Research; Carolyn DiGuiseppi, MD, MPH, PhD, of the University of Colorado; Eric P. Kasten, PhD, and Guoli Zhou, MPH, MD, PhD, of Michigan State University; and Jennifer Pinto-Martin, MPH, PhD, of the University of Pennsylvania.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.