Bipolar women's antepartum psychotropic exposure and offspring risk of attention-deficit/hyperactivity disorder and autism spectrum disorder

Abstract

BackgroundWomen with bipolar disorder (BD) may continue psychotropics during pregnancy. The association of exposure to antidepressant, antipsychotics, and mood stabilizers with offspring risks of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) remains unexplored in mothers with BD. MethodsA total of 5669 pregnant women with BD and 5669 psychiatrically healthy controls were identified between 2002 and 2011 from the Taiwan Longitudinal Health Insurance Database. We analyzed the odds ratios (ORs) of psychotropic types and exposure periods (3 months before pregnancy [3MbPreg] and first, second, and third trimesters [T1, T2, T3, respectively]) on the risk of ADHD and ASD by using adjusted logistic regression analyses. ResultsAntidepressant exposure during 3MbPreg (OR=2.15, 95% CI=1.45–3.20), T1 (OR=2.62, 95% CI=1.68–4.09), T2 (OR=2.33, 95% CI=1.18–4.63), and T3 (OR=2.33, 95% CI=1.67–6.61) was associated with increased offspring risk of ADHD, particularly for selective serotonin reuptake inhibitor and serotonin norepinephrine reuptake inhibitor. Mood stabilizer exposure during 3MbPreg increased the risks of ADHD (OR=2.39, 95% CI=1.45–3.95) and ASD (OR=3.89, 95% CI=1.30–11.65); a higher ADHD risk was associated with valproic acid (OR=2.43, 95% CI=1.32–4.47) and lamotrigine exposure (OR=8.24, 95% CI = 1.49–45.67); ASD risk was higher for lithium exposure (OR=6.75, 95% CI=1.41–32.28). LimitationIn claims-data analyses, several clinical parameters or potential confounders may be incompletely captured. ConclusionsAntidepressants were associated with higher offspring risk of ADHD over all gestation periods among mothers with BD than psychiatrically healthy controls, while mood stabilizers were associated with higher risk of ADHD and ASD during 3MbPreg.