Attention-Deficit/Hyperactivity Disorder in Children Following Prenatal Exposure to Antidepressants: results from the Norwegian Mother, Father and Child Cohort Study

Abstract

Objective

To determine the association between child attention-deficit/hyperactivity disorder (ADHD) and prenatal exposure to selective serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitor antidepressants, by timing and duration, with quantification of bias due to exposure misclassification. Design

Norwegian Mother, Father and Child Cohort Study and national health registries. Setting

Nationwide, Norway. Population

A total of 6395 children born to women who reported depression/anxiety in pregnancy and were either medicated with SSRI/SNRI in pregnancy (n = 818) or non-medicated (n = 5228), or did not report depression/anxiety but used antidepressants 6 months before pregnancy (discontinuers, n = 349). Main outcome measure

Diagnosis of ADHD or filled prescription for ADHD medication in children, and mother-reported symptoms of ADHD by child age 5 years. Results

When the hazard was averaged over the duration of the study follow up, there was no difference in ADHD risk between ever in utero SSRI/SNRI-exposed children and comparators (weighted hazard ratio [wHR] 1.07, 95% CI 0.76–1.51 versus non-medicated; wHR 1.53, 95% CI 0.77–3.07 versus discontinuers). Underestimation of effects due to exposure misclassification was modest. In early childhood, the risk for ADHD was lower with prenatal SSRI/SNRI exposure compared with no exposure, and so were ADHD symptoms (weighted β −0.23, 95% CI −0.39 to −0.08); this risk became elevated at child age 7–9 years (wHR 1.93, 95% CI 1.22–3.05). Maternal depression/anxiety before pregnancy was independently associated with child ADHD. Conclusion

Prenatal SSRI/SNRI exposure is unlikely to considerably increase the risk of child ADHD beyond that posed by maternal depression/anxiety. The elevated risk at child age 7–9 years needs to be elucidated.