Interactive Effects of Prenatal Antidepressant Exposure and Likely Gene Disrupting Mutations on the Severity of Autism Spectrum Disorder.

Only nine participants had both prenatal antidepressant exposure and a likely gene-disrupting mutation, so the interaction finding rests on a very small exposed subgroup. Antidepressant exposure was collected by parent report as broad maternal antidepressant use during pregnancy, without drug name, dose, or duration. The small exposed group also prevented meaningful analysis by trimester. The study analyzed severity in children already diagnosed with autism, not risk of developing autism, so it cannot inform general population risk. Maternal depression was recorded as history, not timed to pregnancy, and some antidepressant exposures occurred without reported maternal depression, anxiety, or bipolar disorder. The significant interactions were among several outcomes, and the exploratory analyses of genes and sex did not establish a mechanism or causal pathway. Participants without a likely gene-disrupting mutation may still have had other genetic variants not captured by the analysis.

The authors reported no conflicts of interest.

Do not conclude that antidepressants in pregnancy worsen autism. The study found no main effect of antidepressant exposure, and the interaction involved only nine children with both antidepressant exposure and a likely gene-disrupting mutation. It also measured severity in children already diagnosed with autism, not risk of developing autism.