The effects of antenatal depression and SSRI exposure on children: A systematic review

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INTRODUCTION: Antenatal depression (AD) affects 7%-13% of pregnant women, with adverse implications for mother and child. Treatment often requires pharmacological intervention, typically with selective serotonin reuptake inhibitors (SSRIs). However, it remains unclear whether SSRIs introduce developmental consequences in children distinct from those associated with AD alone. This systematic review aims to elucidate the behavioral and neurological consequences of AD and prenatal SSRI exposure on child development. METHODS: A systematic review of databases PubMed, PsycInfo, Web of Science, and Scopus was conducted using the PICO framework. Studies were eligible if they included at least two comparison groups: children with exposure to only AD (AD-only) and those exposed to both AD and in utero SSRIs (AD + SSRI). A total of 14 articles were included. RESULTS: Studies report effects of both AD + SSRI and AD-only exposure on several measures. When compared to controls (CON), both AD + SSRI and AD-only displayed alterations in the corticolimbic system, abnormal language development, and increases in internalizing and externalizing problems. Specific to AD + SSRI were alterations in the corticothalamic system and impairment of psychomotor functioning. Specific to AD-only were steeper white matter volume increases across childhood and lower arousal scores as infants. No significant differences between AD + SSRI, AD-only, and CON were reported on attention and interference suppression. Notably, inconsistencies were found on several measurements, for example, IQ, cortical, and subcortical volume. CONCLUSION: We present an updated review of the potential implications of AD and SSRIs on child development. Ultimately, a preponderance of observational studies and numerous confounding factors make their effects difficult to disentangle, underscoring the need for further research.

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