Use of antidepressants during pregnancy linked to poorer math test scores in children

Children whose mothers used antidepressants during pregnancy performed worse on math exams, according to a Danish retrospective study.

The mean math test scores were 52.1 for children exposed to antidepressants in utero versus 57.4 for unexposed children (adjusted difference -2.2, 95% CI -2.7 to -1.6 ), reported Jakob Christensen, DrMedSci, PhD, Aarhus University in Denmark, and colleagues.

However, maternal antidepressant use was not associated with lower scores on standardized language tests (mean scores 53.4 vs. 56.6, respectively; adjusted difference -0.1, 95% CI – 0.6 to 0.3), noted the researchers in JAMA.

The proportion of math test scores in the below-average category was 28.6% among children whose mothers filled prescriptions for antidepressants during pregnancy versus 21.8% among children without exposure (adjusted OR 1.16, 95% CI 1.10-1.22). For language tests, the rates in the below average category were 25.6% and 21.7%, respectively (adjusted OR 1.01, 95% CI 0.96-1.05).

In sensitivity analyzes, the association between lower math scores and maternal prescription refill persisted, but weakened.

“In this study of over 575,000 Danish school-aged children, maternal prescribing of antidepressants during pregnancy was consistently and significantly associated with a lower test score in mathematics but not on language tests after adjusting for multiple potential confounding factors, including socio-economic factors, ”Christensen said. group wrote.

However, the magnitude of the difference in math test scores was “small and of uncertain clinical significance,” they added, noting that their results must be weighed against the benefits of treating depression during. the pregnancy.

In an accompanying editorial, Hilary Brown, PhD, and Simone Vigod, MD, MSc, of the University of Toronto in Canada, said this study adds to an existing body of literature on the use of antidepressants during pregnancy that shows little or no statistically significant difference. in adverse perinatal or infantile outcomes.

Despite the reassuring results of this and other study, “women and clinicians find it difficult to make decisions about antidepressant treatment during pregnancy,” editorialists noted, as it is difficult to balance the benefits of treatment. of depression with the small potential absolute risks of bad outcomes. Future studies that investigate both the harms and benefits of various treatment options for these patients – which also take their values ​​into account – will better inform clinicians about patient counseling, they added.

In this study, Christensen and colleagues analyzed all children born in Denmark from 1997 to 2009. They used national databases to identify children who were exposed to antidepressants in utero, as determined by prescription refills. maternal drugs for tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin and norepinephrine. reuptake inhibitors, and the like. They linked that data to their children’s standardized test scores, including those who took at least one math or language exam from 2010 to 2018.

Researchers adjusted parents’ gender, grade, year of birth, maternal age, maternal education, and psychiatric history, as well as maternal prescription refills for antiepileptic drugs, anxiolytics, and antipsychotics. during pregnancy, among other confounding factors.

Over 575,000 children were included in the analysis, 10,000 of which were born to mothers who filled a prescription for antidepressants during pregnancy. The average age of the children at the time of the test ranged from 9 years in 2nd grade to 15 years in 8th grade.

Christensen and colleagues acknowledged that not all children attended public schools, which may have subjected the study cohort to selection bias. Additionally, the study could not explain maternal depression that did not require hospitalization and assumed that a maternal prescription refill resulted in ingestion of the drug during pregnancy, which may have limited these results.

  • Amanda D’Ambrosio is a reporter on the MedPage Today Corporate and Investigative Team. She covers obstetrics and gynecology and other clinical news, and writes articles on the US healthcare system. To follow


This study was funded in part by the Central Denmark region and the Novo Nordisk Foundation.

Christensen said he received funds from UCB Nordic and Eisai AB during the study. No other disclosures were reported.

Vigod disclosed UpToDate funding for the authorship of documents on depression, antidepressants and pregnancy.

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