In utero exposure to selective serotonin reuptake inhibitors (SSRIs) is associated with decreased brain volume in children, results of a large population-based study show.
However, the researchers, led by Henning Thiemeyer, MD, a professor of social and behavioral sciences at the Harvard T.H. Chan School of Public Health in Boston, say the results should be viewed with caution because the study populations that underwent brain MRI differed in size. It is pointed out that it should be interpreted as follows. It was relatively small.
Thiemeyer said. Medscape Medical News The associations detected were small and could not demonstrate a causal relationship between prenatal SSRI use and reductions in gray and white matter in specific regions of the brain.
“Women who are pregnant and receiving maintenance therapy should discuss with their therapist whether preventive therapy is still necessary or whether there are alternatives. This choice must be carefully considered and women should be cautious. “We need to advise them,” he said.
The study was published online on August 30th. JAMA Psychiatry.
Researchers note that the decision to prescribe antidepressants during pregnancy, especially SSRIs, is difficult. Although her use of SSRIs during pregnancy is generally considered safe, some previous studies suggest an association with adverse effects in the offspring, including adverse effects on neurodevelopment.
However, researchers also found that pregnant women using SSRIs may have other factors, such as more severe depressive symptoms, which are independently associated with adverse outcomes in offspring. He also points out that there is a possibility.
To investigate the association between in utero SSRI exposure and brain development, researchers conducted a prospective cohort study of 3,198 pregnant women with due dates between April 2002 and January 2006. Based research was conducted. Study participants were divided into five groups. Those who used SSRIs during pregnancy, 257 who did not use drugs but had depressive symptoms during pregnancy, 77 who used SSRIs before birth, 74 who developed depressive symptoms after giving birth, SSRIs 2749 controls who had no use or depressive symptoms. The average age of the participants was her 31 years, and all identified as female.
Of those who took SSRIs during pregnancy, 20 used them only during the first trimester, and 21 used them during the first trimester or an additional trimester or two. SSRIs used included paroxetine, fluoxetine, sertraline, fluvoxetine, and sertraline.
The female offspring enrolled in this study underwent MRI at three different times between the ages of 7 and 15 years.
A total of 80 MRI scans were performed on 41 children born to women who took SSRIs prenatally, and 257 children born to mothers who did not take SSRIs but had depressive symptoms during pregnancy. 477 MRI scans were performed, and 126 MRI scans were performed on 77 children born to mothers who took SSRIs before pregnancy. Seventy-four children born to mothers with postpartum depression had only 128 MRI scans, while 2749 children born to mothers without SSRI use or depression had 4813 MRI scans.
The main outcome of this study was offspring brain morphometry, including global and cortical brain volumes, measured by three MRI evaluations from 7 to 15 years of age.
decrease in brain volume
Compared with children not exposed to SSRIs in utero, children exposed to SSRIs had decreased gray and white matter volume, which persisted until age 15 years (P = .006), especially in corticocerebral circuits.
The researchers found that “prenatal SSRI exposure was associated with decreased cortical volumes, including the superior frontal cortex, medial orbitofrontal cortex, parahippocampal gyrus, rostral anterior cingulate cortex, and posterior cingulate cortex, and sustained changes over a 10-year follow-up period. “Relationship” was observed.
Researchers found that prenatal SSRI exposure was consistently associated with a 5% to 10% reduction in brain volume in the frontal, cingulate, and temporal cortices across the age range studied. It pointed out.
However, in some areas of the brain, brain volume gradually increased and returned to levels seen in children not exposed to SSRIs. For example, the small volume of the amygdala increased by age 15, so that children exposed to SSRIs were no different from control children.
A group of women with postpartum depression who used SSRIs before or during pregnancy and had symptoms of depression after giving birth had reduced fusiform gyrus in their newborns (P = .002)
Although Tiemeier was unable to speculate on the impact of the volume differences on children’s development, the parts of the brain that were shown to be reduced are primarily involved in emotional regulation.
The researchers noted that the low prevalence of SSRI use limits their ability to examine trimester-specific outcomes of SSRI use and assess associations with specific SSRIs.
Additionally, the researchers noted that research is needed into the long-term behavioral and psychological consequences associated with the demonstrated brain changes.
Clinical significance is “unknown”
In an accompanying editorial, Dr. Adesheer Talati wrote that although this study deepened our understanding of how brain development throughout adolescence is related to SSRI exposure, it also “particularly affects the limbic system, including the amygdala. The clinical significance was unclear because key areas of the disease normalized over time. . ”
If future evidence links brain abnormalities to adverse outcomes in adolescents, this will need to be “tailored to the risk-benefit profile,” Talati wrote. Until then, she said, the study results should not be interpreted “to promote or discourage the use of antidepressants during the critical period of pregnancy.”
This research was funded by the Netherlands Organization for Scientific Research, the European Union’s Horizon Research and Innovation Program, the Netherlands Agency for Health Research and Development, the Sophia Neuroimaging Foundation, and the European Union’s Horizon Research and Innovation 5 Program.
Talati reported receiving grants from the National Institutes of Health in addition to the submitted research.
JAMA Psychiatry. Published online on August 30, 2023. Full article.Edited text
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