PT  - JOURNAL ARTICLE
AU  - Wiggs, Kelsey Kathleen
AU  - Sujan, Ayehsa C
AU  - Rickert, Martin E
AU  - Quinn, Patrick D
AU  - Larsson, Henrik
AU  - Lichtenstein, Paul
AU  - D'Onofrio, Brian M
AU  - Oberg, A Sara
TI  - Maternal Serotonergic Antidepressant Use in Pregnancy and Risk of Seizures in Children
AID  - 10.1212/WNL.0000000000200516
DP  - 2022 May 11
TA  - Neurology
PG  - 10.1212/WNL.0000000000200516
4099  - http://n.neurology.org/content/early/2022/05/11/WNL.0000000000200516.short
4100  - http://n.neurology.org/content/early/2022/05/11/WNL.0000000000200516.full
AB  - Objective: To evaluate whether children born to women who use serotonergic antidepressants during pregnancy have higher risk of neonatal seizures and epilepsy.Methods: We used Swedish register-based data to examine associations between maternal-reported use of selective-serotonin reuptake inhibitor (SSRI) and selective serotonin-norepinephrine reuptake inhibitors (SNRI) in pregnancy and diagnosis of neonatal seizures and/or epilepsy in over 1.2 million children. To account for systematic differences between exposed and unexposed children we adjusted for a wide range of measured confounders. After first evaluating the role of maternal indication for SSRI/SNRI use (i.e., depression and anxiety) and parental epilepsy, we adjusted for remaining parental background factors (e.g., age, co-morbidities, education, and family socioeconomic indices) and pregnancy-specific characteristics (e.g., maternal use of other psychotropic medications and tobacco smoking in early pregnancy).Results: Compared with all other children, children of women that reported use of SSRI/SNRI in pregnancy had an elevated risk of neonatal seizures and epilepsy (risk ratio [RR]=1.41, 95% confidence interval [CI]=1.03-1.94; hazard ratio [HR]=1.21, 95% CI=1.03-1.43 respectively). The estimates of association were attenuated by adjustment for maternal indications for SSRI/SNRI use (RR=1.30, 95% CI=0.94-1.79; HR = 1.13, 95% CI = 0.95-1.33), but not by additional adjustment for parental history of epilepsy. Full adjustment for all measured parental and pregnancy-specific factors resulted in substantial attenuation of the remaining associations (RR = 1.10, 95% CI = 0.79-1.53; HR = 0.96, 95% CI = 0.81-1.14).Conclusions: The present study found no support for the concern that maternal SSRI/SNRI use in pregnancy increases children’s risk for neonatal seizures or epilepsy.Classification of Evidence: This study provides Class II evidence that exposure to SSRI/SNRI's in the first trimester of pregnancy is not associated with an increased incidence of neo-natal seizures/epilepsy.