Development of children at age 7-8 years after intrauterine exposure to selective serotonin reuptake inhibitors (SSRIs) - Results from the Dutch prospective cohort SMOK study.

Introduction: Selective serotonin reuptake inhibitors (SSRIs) are used by 2-6 % of pregnant women. Safety regarding the neurodevelopment of the child remains unknown.

Aim: To determine the effect of prenatal exposure to SSRIs on children's outcome at age 7-8 years, adjusted for maternal depression and anxiety.

Methods: This study is part of the Dutch SMOK study. Women (n = 107) were included during pregnancy. At age 7-8 years development of 79 children was examined using tests and questionnaires regarding intellectual ability, executive functioning, attention, social responsiveness, behavior and motor development. Maternal depression and anxiety was determined during pregnancy and at the children's assessment. Differences between SSRI-exposed and non-exposed children were tested using multiple linear regression analyses.

Results: All children had lower IQ scores after prenatal exposure to SSRIs but significance was lost after adjustment for maternal psychopathology. No differences in outcome were found on attention and motor development. Boys, not girls, scored significantly lower on Theory of Mind tests when they had been exposed to SSRIs (total norm score 7.9 ± 0.8 vs. 9.6 ± 0.5, p = 0.04; verbal norm score 8.6 ± 0.9 vs. 10.7 ± 0.6, p = 0.02). Scores on the Social Responsiveness Scale measuring social impairment were significantly higher in SSRI-exposed boys (50 ± 2 vs. 45 ± 2, p = 0.03). In girls, outcome on these domains was explained by maternal psychopathology, not by prenatal exposure to SSRIs.

Conclusions: Prenatal exposure to SSRIs is associated with increased risk of behavioral problems and social impairment associated with autism spectrum disorders only in boys.