No Excess Asthma Risk Seen With Prenatal Antidepressant Use

Veronica Hackethal, MD

March 09, 2015

A Danish study has found that children born to women with untreated depression during pregnancy have increased risk for asthma, but prenatal exposure to most antidepressants does not further increase the risk.

"Antidepressant use during pregnancy in general did not increase the risk of asthma in the offspring among women with depression, with the exception of use of older antidepressants," write Xiaoqin Liu, MD, from the Section for Epidemiology, Department of Public Health, Aarhus University, Denmark, and Department of Epidemiology and Social Science on Reproductive Health, Shanghai Institute of Planned Parenthood Research, China, and colleagues. The authors reported their findings in an article published online March 9 in Pediatrics.

Past research has suggested that maternal depression could increase the risk for asthma in offspring. Studies have also linked in utero antidepressant exposure to pulmonary diseases in the offspring and to fetal growth restriction, a risk factor for asthma. Whether or not fetal exposure to antidepressants increases asthma risk, however, remains unclear, the authors note.

Dr Liu and colleagues used Danish national registers to identify all live singleton infants born between 1996 and 2007. They used International Classification of Diseases, 10th Revision, codes to identify mothers diagnosed with depression, and prescription data to find those who received antidepressants 1 year before or during pregnancy. In addition, they used prescription data and hospitalization records to identify children diagnosed with asthma after 3 years of age.

The researchers analyzed data from 733,685 children, of whom 84,683 had a diagnosis of asthma, 21,371 had mothers with maternal depression, and 8895 had mothers who used antidepressants during pregnancy.

Results suggested a 25% increased risk for asthma in children whose mothers had prenatal depression (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.20 - 1.30), as well as a 25% increased risk for asthma among children whose mothers used antidepressants during pregnancy (95% CI, 1.18 - 1.33) compared with the children of mothers without depression.

Compared with children of mothers with untreated prenatal depression, children exposed to prenatal antidepressants did not have increased risk for asthma (HR, 1.00; 95% CI, 0.93 - 1.08). When analyzed by antidepressant type, older antidepressants were associated with an increased risk for asthma, but selective serotonin reuptake inhibitors and newer antidepressants were not (HRs, 1.26 [95% CI, 1.02 - 1.55], 0.95 [95% CI, 0.88 - 1.03]; and 1.11 [95% CI, 0.89 - 1.39], respectively). Tricyclic antidepressants (TCAs) were associated with a 28% increased risk for childhood asthma (HR, 1.28; 95% CI, 1.06 - 1.56).

Children whose fathers had depression or used antidepressants also had increased risk for asthma (HR, 1.11 [95% CI, 1.06 - 1.16]; HR, 1.12 [95% CI, 1.06 - 1.18], respectively). Paternal antidepressant type did not affect asthma risk (selective serotonin reuptake inhibitors: HR, 1.01 [95% CI, 0.91 - 1.12]; newer antidepressants: HR, 0.98 [95% CI, 0.83 - 1.16]; and older antidepressants: HR, 1.09 [95% CI, 0.93 - 1.29]).

The authors note several study limitations, including confounding that was not accounted for. In addition, TCAs are often used to treat more severe depression, they note, so women prescribed TCAs during pregnancy could have a more severe form of the disorder.

"Maternal antidepressant use during pregnancy did not increase the risk of asthma except for use of older antidepressants," Dr Liu and colleagues conclude. "This finding could reflect confounding by the severity of maternal depression."

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online March 9, 2015.

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