Antidepressant use during pregnancy has increased over the past decade, underscoring the need to evaluate long-term developmental safety in children. We examined prenatal antidepressant exposure in relation to language outcomes at ages 5 and 8 years among women with depressive/anxiety disorders diagnosed before pregnancy.
We used data from the MoBa study linked to Medical Birth Registry of Norway and the Norwegian Patient Registry (NPR). Eligible pregnancies were restricted to women with a documented history of depressive/anxiety disorders prior to pregnancy. Antidepressant exposure was assessed by maternal self-report during pregnancy and examined in two ways: (1) exposure groups comparing continuers with discontinuers and unexposed women, and (2) timing of use. Child language outcomes were assessed at age 5 and 8 years using Språk 20 and Children’s Communication Checklist-2 (CCC-2), and by ICD-10 diagnostic codes from NPR. We conducted confirmatory factor analysis of CCC-2 at 8 years to evaluate the measurement structure and derived factor scores. We estimated associations between antidepressant use and child language outcomes using generalized linear models, modified Poisson regression and marginal structural models with inverse probability of treatment and censoring weights to address time-varying exposure, confounding and loss to follow-up.
The study sample included 4518 (5-year questionnaire), 4538 (8-year questionnaire) and 4604 (NPR) mother-child dyads. Antidepressant continuation during pregnancy was not associated with language outcomes at 5 years compared with discontinuation [Språk 20 aRR: 1.21 (0.82, 1.77); CCC-2 aβ: 0.02 (-0.39, 0.44)]. Among women with antidepressants use, neither early [Språk 20 aRR 0.91 (0.54, 1.53); CCC-2 aβ: -0.03 (-0.47, 0.42)] nor late use [Språk 20 aRR 1.23 (0.66, 2.27); CCC-2 aβ: -0.28 (-0.82, 0.26)] was associated with language outcomes at 5 years. Findings were similar at 8 years and for NPR outcomes.
In this cohort study among women with pre-pregnancy depressive/anxiety disorders, prenatal antidepressant exposure was not associated with language difficulties at ages 5 or 8 years. Residual confounding and exposure misclassification cannot be excluded and should be considered when interpreting these findings.