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

Introduction: Antenatal depression (AD) affects 7-13% of pregnant women and has adverse implications for both mother and child. Treatment of AD often requires pharmacological intervention, typically with selective serotonin reuptake inhibitors (SSRIs). However, it remains unclear whether SSRI interventions introduce developmental complications in children that are distinct from those associated with AD. This systematic review aims to investigate the current literature on the effects of AD and prenatal SSRI exposure and its behavioral and neurological consequences for child development.Methods: A systematic review of databases PubMed, PsycInfo, Web of Science and Scopus were conducted using the PICO framework. Studies utilizing at least two participants groups, one group of children exposed to AD and another exposed to AD and in utero SSRI exposure, were eligible for inclusion. Screening yielded 14 articles on neurodevelopmental and/or behavioral outcomes.Results: Studies report effects of both prenatal SSRI exposure and AD-only exposure on several measures. Notably, when compared to non-exposed both SSRI and AD-only exposed children displayed alterations in the corticolimbic system, abnormal language development, and increases in internalizing and externalizing problems. Specific to SSRI-exposed children were alterations in the corticothalamic system, lower full-scale IQ, and impairment of psychomotor functioning.Conclusion: This systematic review presents updated information relevant to professionals involved in clinical decision-making. Importantly, potentially confounding effects of AD phenotype, environmental factors and maternal care are difficult to entangle from the effects of SSRIs. Ultimately, more studies with multimodal methods and longitudinal measurements are needed to precisely understand how SSRIs and AD influence development.