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Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: a systematic review

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Abstract

Antidepressant and anxiolytic medications are widely prescribed and used by pregnant women for acute and maintenance therapy. These drugs are able to pass the placental barrier, and may potentially influence fetal and brain development. It is possible that exposure to prenatal antidepressants or anxiolytic medication may disturb neurotransmitter systems in the brain and have long-lasting consequences on neurodevelopment in the offspring. As all medication during pregnancy may pose a certain risk to the developing fetus, the potential benefits of the medication must be weighed against the risks for both mother and her unborn child. Therefore, information to guide patients and physicians to make a well-balanced decision for the appropriate treatment during pregnancy is needed. In this systematic review, an overview of maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes is provided. Some studies indicate a relation between prenatal exposure to antidepressants and adverse neurodevelopmental outcomes such as delayed motor development/motor control, social difficulties, internalizing problems and autism, but cannot rule out confounding by indication. Overall, the results of the observational studies have been inconsistent, which makes translation of the findings into clinical recommendations difficult. More well-designed observational studies and also randomized controlled trials (e.g., maintenance treatment vs. cessation) are needed to move forward and provide a comprehensive evaluation of the risks and benefits of antidepressant and anxiolytic use during pregnancy.

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Acknowledgments

We gratefully thank W.M. Bramer (professional librarian at the Erasmus MC) for his extensive assistance in the systematic literature searches.

The Sophia Children’s Hospital Fund (SSWO-616) supported this work financially. The Netherlands Organization for Scientific Research (NWO Brain and Cognition Program Grant 433-09-311 and VIDI Grant 017.106.370). The funding agencies had no role in the design and conduct of the study, collection, management, analyses and interpretation of the data; and preparation, review or approval of the manuscript.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. The Department of Child and Adolescent Psychiatry, Erasmus MC, Sophia Children’s Hospital, 3000 CB, Rotterdam, The Netherlands

    Hanan El Marroun, Tonya White, Frank C. Verhulst & Henning Tiemeier

  2. The Department of Radiology, Erasmus MC, 3000 CA, Rotterdam, The Netherlands

    Tonya White

  3. The Department of Psychiatry, Erasmus MC, 3000 CA, Rotterdam, The Netherlands

    Henning Tiemeier

  4. The Department of Epidemiology, Erasmus MC, 3000 CA, Rotterdam, The Netherlands

    Henning Tiemeier

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  1. Hanan El Marroun
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  2. Tonya White
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  3. Frank C. Verhulst
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  4. Henning Tiemeier
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Correspondence to Hanan El Marroun.

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El Marroun, H., White, T., Verhulst, F.C. et al. Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: a systematic review. Eur Child Adolesc Psychiatry 23, 973–992 (2014). https://doi.org/10.1007/s00787-014-0558-3

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  • DOI: https://doi.org/10.1007/s00787-014-0558-3

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