Skip to main content Accessibility help

Autism risk following antidepressant medication during pregnancy

  • A. Viktorin (a1) (a2) (a3), R. Uher (a4), A. Reichenberg (a1) (a2), S. Z. Levine (a5) and S. Sandin (a1) (a2) (a3)...



Previous studies have examined if maternal antidepressant medication during pregnancy increase the risk of autism spectrum disorder (ASD) in the offspring, but the results have been conflicting.


In a population-based cohort of 179 007 children born in 2006 and 2007 and followed through 2014 when aged 7 and 8, we estimated relative risks (RRs) of ASD and 95% confidence intervals (CIs) from Cox regression in children exposed to any antidepressant medication during pregnancy, and nine specific antidepressant drugs. Analyses were adjusted for potential confounders and were conducted in the full population sample, and in a clinically relevant sub-sample of mothers with at least one diagnosis of depression or anxiety during life.


The adjusted RR of ASD in children of mothers who used antidepressant medication during pregnancy was estimated at 1.23 (95% CI 0.96–1.57), and at 1.07 (95% CI 0.80–1.43) in women with a history of depression or anxiety. Analyses of specific antidepressants initially revealed increased RRs of offspring ASD confined to citalopram and escitalopram (RR: 1.47; 95% CI 0.92–2.35) and clomipramine (RR: 2.86; 95% CI 1.04–7.82).


Medication with antidepressants during pregnancy does not appear to be causally associated with an increased risk of ASD in the offspring. Instead, the results suggest that the association is explained by factors related to the underlying susceptibility to psychiatric disorders. Based on these findings, the risk of ASD in the offspring should not be a consideration to withhold treatment with commonly used antidepressant drugs from pregnant women.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Autism risk following antidepressant medication during pregnancy
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Autism risk following antidepressant medication during pregnancy
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Autism risk following antidepressant medication during pregnancy
      Available formats


This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Address for correspondence: A. Viktorin, Department of Psychiatry, Icahn School of Medicine, Mount Sinai, One Gustave L Levy Place, Box #1230, New York, NY 10029, USA. (Email:


Hide All
Andrade, SE, Raebel, MA, Brown, J, Lane, K, Livingston, J, Boudreau, D, Rolnick, SJ, Roblin, D, Smith, DH, Willy, ME, Staffa, JA, Platt, R (2008). Use of antidepressant medications during pregnancy: a multisite study. American Journal of Obstetrics & Gynecology 198, 194e1194e5.
Bakker, MK, Kolling, P, van den Berg, PB, de Walle, HE, de Jong van den Berg, LT (2008). Increase in use of selective serotonin reuptake inhibitors in pregnancy during the last decade, a population-based cohort study from the Netherlands. British Journal of Clinical Pharmacology 65, 600606.
Boukhris, T, Sheehy, O, Mottron, L, Bérard, A (2016). Antidepressant use during pregnancy and the risk of autism spectrum disorder in children. JAMA Pediatrics 170, 117124.
Castro, V, Kong, S, Clements, C, Brady, R, Kaimal, A, Doyle, A, Robinson, E, Churchill, S, Kohane, I, Perlis, R (2016). Absence of evidence for increase in risk for autism or attention-deficit hyperactivity disorder following antidepressant exposure during pregnancy: a replication study. Translational Psychiatry 6, e708.
Cipriani, A, Furukawa, TA, Salanti, G, Geddes, JR, Higgins, JP, Churchill, R, Watanabe, N, Nakagawa, A, Omori, IM, McGuire, H, Tansella, M, Barbui, C (2009). Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet 373, 746758.
Clements, CC, Castro, VM, Blumenthal, SR, Rosenfield, HR, Murphy, SN, Fava, M, Erb, JL, Churchill, SE, Kaimal, AJ, Doyle, AE (2015). Prenatal antidepressant exposure is associated with risk for attention-deficit hyperactivity disorder but not autism spectrum disorder in a large health system. Molecular Psychiatry 20, 727734.
Cnattingius, S, Ericson, A, Gunnarskog, J, Kallen, B (1990). A quality study of a medical birth registry. Scandinavian Journal of Social Medicine 18, 143148.
Croen, LA, Grether, JK, Yoshida, CK, Odouli, R, Hendrick, V (2011). Antidepressant use during pregnancy and childhood autism spectrum disorders. Archives of General Psychiatry 68, 11041112.
Efron, B, Tibshirani, RJ (1994). An Introduction to the Bootstrap. Chapman and Hall/CRC Press: London.
Ekbom, A (2011). The Swedish multi-generation register. Methods in Molecular Biology 675, 215220.
Gidaya, NB, Lee, BK, Burstyn, I, Yudell, M, Mortensen, EL, Newschaffer, CJ (2014). In utero exposure to selective serotonin reuptake inhibitors and risk for autism spectrum disorder. Journal of Autism and Developmental Disorders 44, 25582567.
Grambsch, PM, Therneau, TM (1994). Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 81, 515526.
Harrington, RA, Lee, L-C, Crum, RM, Zimmerman, AW, Hertz-Picciotto, I (2014). Prenatal SSRI use and offspring with autism spectrum disorder or developmental delay. Pediatrics 133, e1241e1248.
Hogberg, U, Larsson, N (1997). Early dating by ultrasound and perinatal outcome. A cohort study. Acta Obstetricia et Gynecologica Scandinavica 76, 907912.
Holm, S (1979). A simple sequentially rejective multiple test procedure. Scandinavian Journal of Statistics 6, 6570.
Hviid, A, Melbye, M, Pasternak, B (2013). Use of selective serotonin reuptake inhibitors during pregnancy and risk of autism. New England Journal of Medicine 369, 24062415.
Idring, S, Rai, D, Dal, H, Dalman, C, Sturm, H, Zander, E, Lee, BK, Serlachius, E, Magnusson, C (2012). Autism spectrum disorders in the Stockholm Youth Cohort: design, prevalence and validity. PLoS ONE 7, e41280.
International Schizophrenia Consortium, Purcell, SM, Wray, NR, Stone, JL, Visscher, PM, O'Donovan, MC, Sullivan, PF, Sklar, P (2009). Common polygenic variation contributes to risk of schizophrenia and bipolar disorder. Nature 460, 748752.
Jokiranta, E, Brown, AS, Heinimaa, M, Cheslack-Postava, K, Suominen, A, Sourander, A (2013). Parental psychiatric disorders and autism spectrum disorders. Psychiatry Research 207, 203211.
Lecrubier, Y (2001). The burden of depression and anxiety in general medicine. Journal of Clinical Psychiatry 62(Suppl. 8), 49; discussion 10-1.
Lichtenstein, P, Yip, BH, Bjork, C, Pawitan, Y, Cannon, TD, Sullivan, PF, Hultman, CM (2009). Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. Lancet 373, 234239.
Ludvigsson, JF, Andersson, E, Ekbom, A, Feychting, M, Kim, JL, Reuterwall, C, Heurgren, M, Olausson, PO (2011). External review and validation of the Swedish national inpatient register. BMC Public Health 11, 450.
Ludvigsson, JF, Otterblad-Olausson, P, Pettersson, BU, Ekbom, A (2009). The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. European Journal of Epidemiology 24, 659667.
Malm, H, Brown, AS, Gissler, M, Gyllenberg, D, Hinkka-Yli-Salomaki, S, McKeague, IW, Weissman, M, Wickramaratne, P, Artama, M, Gingrich, JA, Sourander, A (2016). Gestational exposure to selective serotonin reuptake inhibitors and offspring psychiatric disorders: a national register-based study. Journal of the American Academy of Child and Adolescent Psychiatry 55, 359366.
Marmorstein, NR, Malone, SM, Iacono, WG (2004). Psychiatric disorders among offspring of depressed mothers: associations with paternal psychopathology. American Journal of Psychiatry 161, 15881594.
Meltzer-Brody, S, Stuebe, A (2014). The long-term psychiatric and medical prognosis of perinatal mental illness. Best Practice & Research Clinical Obstetrics & Gynaecology 28, 4960.
O'Hara, MW, McCabe, JE (2013). Postpartum depression: current status and future directions. Annual Review of Clinical Psychology 9, 379407.
Olfson, M, Marcus, SC (2009). National patterns in antidepressant medication treatment. Archives of General Psychiatry 66, 848856.
Rai, D, Lee, BK, Dalman, C, Golding, J, Lewis, G, Magnusson, C (2013). Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: population based case-control study. BMJ 346, f2059.
Sandin, S, Schendel, D, Magnusson, P, Hultman, C, Suren, P, Susser, E, Gronborg, T, Gissler, M, Gunnes, N, Gross, R, Henning, M, Bresnahan, M, Sourander, A, Hornig, M, Carter, K, Francis, R, Parner, E, Leonard, H, Rosanoff, M, Stoltenberg, C, Reichenberg, A (2016). Autism risk associated with parental age and with increasing difference in age between the parents. Molecular Psychiatry 21, 693700.
Sorensen, MJ, Gronborg, TK, Christensen, J, Parner, ET, Vestergaard, M, Schendel, D, Pedersen, LH (2013). Antidepressant exposure in pregnancy and risk of autism spectrum disorders. Clinical Epidemiology 5, 449459.
Sullivan, PF, Daly, MJ, O'Donovan, M (2012). Genetic architectures of psychiatric disorders: the emerging picture and its implications. Nature Reviews Genetics 13, 537551.
Wettermark, B, Hammar, N, Fored, CM, Leimanis, A, Otterblad Olausson, P, Bergman, U, Persson, I, Sundstrom, A, Westerholm, B, Rosen, M (2007). The new Swedish Prescribed Drug Register – opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiology and Drug Safety 16, 726735.
WHO (2006). The Anatomical Therapeutic Chemical Classification System with Defined Daily Doses (ATC/DDD). WHO: Oslo.


Related content

Powered by UNSILO
Type Description Title
Supplementary materials

Viktorin supplementary material

 Word (5.7 MB)
5.7 MB

Autism risk following antidepressant medication during pregnancy

  • A. Viktorin (a1) (a2) (a3), R. Uher (a4), A. Reichenberg (a1) (a2), S. Z. Levine (a5) and S. Sandin (a1) (a2) (a3)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.