Prenatal antidepressant use and risk of attention-deficit/hyperactivity disorder in offspring: population based cohort study [产前抗抑郁药使用和后代注意力缺陷/多动障碍的风险：基于人群的队列研究]

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BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2350 (Published 31 May 2017)
Cite this as: BMJ 2017;357:j2350

Authors
Kenneth K C Man, Esther W Chan, Patrick Ip, David Coghill, Emily Simonoff, Phyllis K L Chan, Wallis C Y Lau, Martijn J Schuemie, Miriam C J M Sturkenboom, Ian C K Wong

Abstract
Objective To assess the potential association between prenatal use of antidepressants and the risk of attention-deficit/hyperactivity disorder (ADHD) in offspring.

Design Population based cohort study.

Setting Data from the Hong Kong population based electronic medical records on the Clinical Data Analysis and Reporting System.

Participants 190 618 children born in Hong Kong public hospitals between January 2001 and December 2009 and followed-up to December 2015.

Main outcome measure Hazard ratio of maternal antidepressant use during pregnancy and ADHD in children aged 6 to 14 years, with an average follow-up time of 9.3 years (range 7.4-11.0 years).

Results Among 190 618 children, 1252 had a mother who used prenatal antidepressants. 5659 children (3.0%) were given a diagnosis of ADHD or received treatment for ADHD. The crude hazard ratio of maternal antidepressant use during pregnancy was 2.26 (P<0.01) compared with non-use. After adjustment for potential confounding factors, including maternal psychiatric disorders and use of other psychiatric drugs, the adjusted hazard ratio was reduced to 1.39 (95% confidence interval 1.07 to 1.82, P=0.01). Likewise, similar results were observed when comparing children of mothers who had used antidepressants before pregnancy with those who were never users (1.76, 1.36 to 2.30, P<0.01). The risk of ADHD in the children of mothers with psychiatric disorders was higher compared with the children of mothers without psychiatric disorders even if the mothers had never used antidepressants (1.84, 1.54 to 2.18, P<0.01). All sensitivity analyses yielded similar results. Sibling matched analysis identified no significant difference in risk of ADHD in siblings exposed to antidepressants during gestation and those not exposed during gestation (0.54, 0.17 to 1.74, P=0.30).

Conclusions The findings suggest that the association between prenatal use of antidepressants and risk of ADHD in offspring can be partially explained by confounding by indication of antidepressants. If there is a causal association, the size of the effect is probably smaller than that reported previously.