ASD affects an estimated 1%-2% of the population. Multiple studies published over the past decade indicate that it is a highly heritable illness. Genetic factors clearly play an important role, and family history of psychiatric disorder is a major risk factor for ASD. Other studies have suggested a multifactorial model that includes environmental and genetic factors as possible causative factors.
Therefore, while the authors suggest that SSRI exposure may contribute to risk for ASD, they have failed to adequately or accurately quantify one of the strongest, most well-established risk factors for ASD, namely family or personal history of psychiatric disorder. One can hypothesize that women with a more severe underlying psychiatric disorder would be using antidepressants during pregnancy, given the high threshold for using these medicines or any other medicines during pregnancy.
Opportunities to refine our understanding of clinical questions with major public health implications are always welcome. But one does have to wonder about the value of these analyses, when the quality of data in the studies is of questionable reliability.
Clearly, decisions regarding use of any medication, including psychotropics, have to be made on a case-by-case basis. But at least some of these new findings tend to complicate, if not obscure, the most thoughtful clinical path as patients struggle to understand frequently conflicting data in the literature about SSRIs, which are frequently prescribed during pregnancy. Perhaps clinicians then should consider this latest study as a very preliminary report with findings that are far from definitive until we have better prospectively ascertained data regarding the longer-term behavioral sequelae of fetal exposure to SSRIs.
Dr. Cohen directs the perinatal psychiatry program at Massachusetts General Hospital, Boston, which provides information about pregnancy and mental health at http://www.womensmentalhealth.org/. He has been a consultant to manufacturers of SSRIs. Dr. Cohen said he had no relevant financial disclosures.
This column, "Drugs, Pregnancy, and Lactation," appears regularly in Ob.Gyn. News, a publication of Elsevier. To respond to this column, e-mail Dr. Cohen at obnews@elsevier.com.