Prescription Drugs, Pregnancy and Autism

Two new studies just published in highly respected journals suggest that when certain commonly prescribed medications are taken during pregnancy they may increase the risk for autism in exposed children.
The first study was published in BMJ (formerly the British Medical Journal). Researchers from Sweden analyzed birth registries and determined which children were exposed to SSRI-type antidepressants (drugs like fluoxetine, paroxetine or sertraline, etc) and which ones were exposed to tricyclic antidepressants (amitriptyline, desipramine, doxepin, nortriptyline, etc) in utero (BMJ, April 19, 2013). The investigators concluded:
“In utero exposure to both SSRIs and… tricyclic antidepressants was associated with an increased risk of autism spectrum disorders, particularly without intellectual disability.”
This is not the first time research has suggested that there might be a relationship between selective serotonin reuptake inhibitor (SSRIs) exposure in utero and autism. A study in the Archives of General Psychiatry in 2011 also pointed in this direction.
The authors of the BMJ research were very cautious about their findings. They point out that depression itself might increase the risk for autism in the baby and this has to be ruled out. Others are not so surprised that powerful medications that affect the brain of the mother might also have an impact on the brain of the developing fetus.
This is especially disconcerting in light of a study just published in the Journal of the American Medical Association (JAMA, April 24, 2013). Danish researchers tracked the impact of an antiseizure drug called valproate (Depakene, Depakote) when taken during pregnancy. The authors conclude:
“Maternal use of valproate during pregnancy was associated with a significantly increased risk of autism spectrum disorder and childhood autism in the offspring, even after adjusting for maternal epilepsy. For women of childbearing potential who use antiepileptic medications, these findings must be balanced against treatment benefits for women who require valproate for epilepsy control.”
The increased risk for autism was substantial in children exposed to this anti-seizure medicine.
The American Academy of Neurology has recommended against the use of valproate during pregnancy whenever possible, as the drug has also been linked to birth defects and “reduced cognitive abilities.” An editorial in the same issue of JAMA concluded:
“The investigation by Christensen el al provides the strongest evidence to date that fetal valproate exposure is associated with increased risks of autism and autism spectrum disorder.”
Because valproate is also prescribed to treat pain, bipolar disorder and other conditions, the risks extend beyond women with epilepsy. Doctors and women who may become pregnant need to understand that many medications could affect the developing fetus. If at all possible, it would be wise to be very cautious about which drugs are taken during pregnancy or even before conception. That also extends to over-the-counter medications and dietary supplements, which may seem harmless but could pose unexpected problems.