Prenatal exposure to maternal depression and antidepressants and neurodevelopmental outcomes: A population cohort study
- 1School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- 2School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
Abstract
Background: The long-term effects of antidepressant use in pregnancy on child neurodevelopment are unclear; meanwhile antidepressant use in pregnancy is increasing. We aimed to clarify associations between prenatal maternal depression and/or antidepressant exposure and neurodevelopmental outcomes in school-age children. Methods and findings: This population-wide cohort study included 167,447 children born in Wales, UK between 2009 and 2016, followed until 2022 (mean age 5.68 years) using linked primary care, maternity and education records. Exposures were one or more antidepressant prescriptions during pregnancy or up to one month before conception, and/or maternal depression diagnosis recorded in the two years before delivery. Outcomes were all-cause and cause-specific special educational need (SEN), including autism spectrum disorder (ASD), sensory impairment, communication difficulties, learning difficulties, physical and medical difficulties, and behavioral-emotional-social difficulties, as well as attention deficit hyperactivity disorder (ADHD). Generalized estimating equation models with an interaction term between maternal depression and antidepressant exposure were used to investigate SEN and causes of SEN. Predicted probabilities and marginal effects were derived to quantify absolute risk. Separate models were fitted for individual antidepressant classes and combinations. Cox proportional hazards regression and flexible parametric survival models were used for time to ADHD diagnosis. Covariates included child sex, area-level deprivation quintile, ethnicity, age, maternal age, smoking, parity, multiple birth and epilepsy. Conclusions: Offspring of mothers with depression have a higher risk of SEN that cannot be attributed solely to antidepressant exposure. Prenatal exposure to antidepressants may confer a small additional absolute risk, but findings may partly represent confounding by depression severity. Further research is needed. Why was this study done?: What did the researchers do and find?: What do these findings mean?: In this study of more than 167,000 children in Wales, Saraid McIlvride and colleagues examined how prenatal exposure to maternal depression and antidepressants relates to later neurodevelopmental outcomes. The findings suggest that children exposed to maternal depression had higher rates of special educational needs.
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BibTeX
@article{mcilvride2026prenatal,
title = {{Prenatal exposure to maternal depression and antidepressants and neurodevelopmental outcomes: A population cohort study}},
author = {Saraid McIlvride and Neha Rao and Sarjit Singh and Scott M. Nelson and Jill P. Pell and Michael Fleming},
journal = {PLOS Medicine},
year = {2026},
month = sep,
doi = {10.1371/journal.pmed.1004658},
url = {https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004658},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Prenatal exposure to maternal depression and antidepressants and neurodevelopmental outcomes: A population cohort study
AU - Saraid McIlvride
AU - Neha Rao
AU - Sarjit Singh
AU - Scott M. Nelson
AU - Jill P. Pell
AU - Michael Fleming
PY - 2026
DA - 2026/09/29
JO - PLOS Medicine
DO - 10.1371/journal.pmed.1004658
UR - https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004658
AB - Background: The long-term effects of antidepressant use in pregnancy on child neurodevelopment are unclear; meanwhile antidepressant use in pregnancy is increasing. We aimed to clarify associations between prenatal maternal depression and/or antidepressant exposure and neurodevelopmental outcomes in school-age children. Methods and findings: This population-wide cohort study included 167,447 children born in Wales, UK between 2009 and 2016, followed until 2022 (mean age 5.68 years) using linked primary care, maternity and education records. Exposures were one or more antidepressant prescriptions during pregnancy or up to one month before conception, and/or maternal depression diagnosis recorded in the two years before delivery. Outcomes were all-cause and cause-specific special educational need (SEN), including autism spectrum disorder (ASD), sensory impairment, communication difficulties, learning difficulties, physical and medical difficulties, and behavioral-emotional-social difficulties, as well as attention deficit hyperactivity disorder (ADHD). Generalized estimating equation models with an interaction term between maternal depression and antidepressant exposure were used to investigate SEN and causes of SEN. Predicted probabilities and marginal effects were derived to quantify absolute risk. Separate models were fitted for individual antidepressant classes and combinations. Cox proportional hazards regression and flexible parametric survival models were used for time to ADHD diagnosis. Covariates included child sex, area-level deprivation quintile, ethnicity, age, maternal age, smoking, parity, multiple birth and epilepsy. Conclusions: Offspring of mothers with depression have a higher risk of SEN that cannot be attributed solely to antidepressant exposure. Prenatal exposure to antidepressants may confer a small additional absolute risk, but findings may partly represent confounding by depression severity. Further research is needed. Why was this study done?: What did the researchers do and find?: What do these findings mean?: In this study of more than 167,000 children in Wales, Saraid McIlvride and colleagues examined how prenatal exposure to maternal depression and antidepressants relates to later neurodevelopmental outcomes. The findings suggest that children exposed to maternal depression had higher rates of special educational needs.
SN - 1549-1676
ER -