As the mother of an adult daughter with autism, I watch the news in this area very closely. We still don’t know what causes autism spectrum disorder (ASD) or why rates appear to have increased dramatically during the last 20 years or so.
One thing that has definitely changed since I was pregnant with my three daughters, all now in their 30s, is an increased willingness on the part of physicians to prescribe medications to pregnant women. When my girls were en route, you had better have a life-threatening condition before you were allowed to continue to use medication, even common over-the-counter medications. Towards the end of my pregnancy with my oldest, I started to produce too much of the hormone that loosens your ligaments, allowing bones to move a bit to make the birth process work. This produced a practical joke amount of back pain–I’ve never felt anything worse, including the contractions themselves, and it lasted for several days. My physician, however, told me sternly than I just needed to ride it out, as taking any kind of pain reliever, even something like Tylenol, was not acceptable. Today, it is relatively commonplace for women to use medications during pregnancy. The CDC reports that 90% of pregnant women take at least one medication, and 70% take a prescription medication. Over the past 30 years, use of prescription medications during the first trimester has increased more than 60%, and the number of women using four or more medications has more than doubled.
The CDC reports that about 8% of pregnant women use some type of antidepressant, and most of these are SSRIs. Further, the CDC reports that medication is the most likely treatment for women (pregnant and non-pregnant) between the ages of 18 and 49.
Because of the common use of SSRIs during pregnancy, observed relationships between SSRI use and increased risk for ASD in offspring are troubling. Not all studies have shown a relationship, but increasingly, meta-analyses are reporting similar numbers–the risk of autism is approximately doubled in offspring of women using SSRIs during pregnancy. Given the fact that cognitive behavioral therapy (CBT) has demonstrable efficacy in perinatal populations in both preventing and treating depression, it appears that a more cautious approach on the part of physicians is warranted.
This is clearly a “hot button” issue. Blogs immediately appeared right after the Dec 14, 2015 JAMA article linked above reassuring women that their SSRIs were not a problem. Silly me–although I rarely wade into discussions on Facebook, I commented on one blog appearing in my news feed, noting that the author implied that medication was the only way to treat depression, but equally effective alternatives exist. Wow. you would have thought I stated the the world was flat or something.
I would not wish guilt onto women who may have contributed to their child’s autism because they took medication during pregnancy. All of us who have special needs children already feel that nagging guilt–what did we do wrong? I think the message is more appropriately directed to the medical community. Why not encourage pregnant women to at least consider non-medication treatments for depression?
18 Comments
jessicametzinger · January 16, 2016 at 7:42 pm
I had wondered about this for a long time, because I plan to have children some day but have been taking Prozac for severe anxiety for quite a while now (my parents didn’t want to medicate me at first, but I did a whole year of CBT and still saw zero improvement– it was a last resort). I assumed that there were definitely some risks, so this blog post really stood out to me. I agree that unless completely necessary, women should not take medication while pregnant, and doctors should not encourage it. This research will be helpful in the future for many women who want to have children because hopefully it makes them think twice before doing so while still on medication.
Laura Freberg · January 17, 2016 at 2:14 pm
Jessica, thank you for your thoughtful comments. Much work is being done in this area, so our knowledge should continue to grow. My guess is that this information is most useful for women who have a known risk for autism, such as having a sibling or other close relative with the disorder. But time (and more data) should tell.
hannahphelps · January 18, 2016 at 12:39 pm
This article brings up a topic I have discussed on multiple occasions with my mother. My mom, being an LCSW, has showed me the successes of there forms of treatment for depression (and other psychological disorders) aside from medication. While I think medication is oftentimes necessary and extremely beneficial for those with serious need, I also think our society is one that turns to over-medicating as the first step in treatment. In regards to pregnancy, it seems this should be the time a woman is even more aware and cautious of this issue. While I do not believe that all medication taken during pregnancy is harmful to the baby, I think we should be weary of how it can effect this crucial time development by seeking out other options to aid a mother’s depression (or other issues, as mentioned). As can probably be concluded, I have failed to personally draw a black or white conclusion as to if all medication is detrimental during pregnancy or not; however, it is something I have put some consideration to and hope to see more research in to aid me in my own future of potentially becoming a mother.
Laura Freberg · January 18, 2016 at 3:15 pm
Hi, Hannah.
I am always a bit surprised when people assume that medication is the ONLY approach to depression, and I’m glad your mom has been able to help using other methods. It is my understanding, although I am not a licensed clinician of course, that outcome studies show equal success for medication alone, cognitive behavioral therapy alone, and aerobic exercise alone. Not every approach works for every person, but overall, there are multiple options to explore. I think it’s safe, until we know for certain, to avoid medications during pregnancy unless the mother’s health is at risk. If something is optional, it can wait nine months, right?
BrittanyNelson · January 27, 2016 at 8:19 pm
As someone interested in going into the heath field, I agree that pregnant women should not be encouraged to take medications until a last resort. I believe the only exception would be if taking the mother off of a medication would be life-threatening to her, but other than those cases the health of the baby is the priority. In the course of evolution, medications were not used, especially during pregnancy. It is not surprising to see these adverse effects on the babies with the immense amount of medications we subject our bodies to. I find it very important to look at more holistic options before prescribed medication, especially in the case of pregnant women.
Minnie · February 7, 2016 at 10:44 pm
I don’t know much about this issue with medication linked to Austim. I am a bit confused still on the link, or potential link, to medication and autism. I myself am not a big fan of medication in many respects unless it is necessary, but I don’t have much of an issue when others do it. What I am wondering is what research studies have touched on the link between the two?
Laura Freberg · February 8, 2016 at 3:54 pm
Hi, Minnie.
Because we don’t know exactly what causes autism, the best we can do is search for correlates. We need to find something that has changed dramatically in the last 20-25 years or so, because we began seeing a big uptick in numbers of autism cases. One of the things that has changed during that period is the use of prescription and over-the-counter medications during pregnancy. These were absolutely forbidden unless you were on the verge of death (and I’m not completely kidding here) when I had my babies 30 years ago. Now, lots of doctors are comfortable prescribing even optional drugs like SSRIs to pregnant women. The SSRIs are particularly interesting, because we know that children with autism have unusually high circulating serotonin levels.
On the other hand, we also know the causes of autism are complex. I have a daughter with autism, and I was such a purist that I did not consume coffee, tea, or even chocolate during my pregnancies, let alone any type of medication or alcohol. I would suggest that people who otherwise fit the profile of parents at risk for having a child with autism (older, systematic thinking professions, other family members with autism and related disorders) should be especially careful about medications during pregnancy.
annaliseconroy · February 28, 2016 at 11:18 pm
Hi there Dr. Freberg,
Thank you for being open with your experiences as they relate to the topic. It’s extremely interesting to read about the possible “causes” or correlations due to ASD. I did my final report in PSY 405 on ASD and the many correlating factors such as medication. I have come to believe that as a whole society has become over medicated and many doctors may be prescribing due to financial benefit. I know my mom tells me she never went to the doctor as a kind, she just dealt with her sore throat. These days it seems every college kid with a cold wants to start antibiotics.
As it relates to pregnancy and wanting the best conditions for the baby, I know I would not take any risks when it comes to my child’s health. Even if a factor with a positive correlation to ASD did not have proof of cause, I would air on the side of precaution and stay away.
estrickf · April 22, 2016 at 4:59 pm
This topic is especially interesting to me as someone who is interested in genetic counseling as a career. The decision to use medications during pregnancy is one that should be made precautiously, considering its potential effects on the fetus. It is true that in the past, medications may not have been used during pregnancy because the resources were not available to determine the effects on the child. However, more modern technology has been made available to conduct research in this area. Based on the findings in your article, it does not sound like there is an obvious correlation between medication use during pregnancy and producing offspring with ASD. However, I would like to see more studies done on this topic to determine how closely the relationship is between the two and how heritable ASD is in one’s genetic makeup before claiming that one side is better than the other. This is because we know of the many benefits of medicine pregnant or not.
Laura Freberg · April 23, 2016 at 5:55 am
I have a former student who has an inside on an internship for the summer that is relevant to genetics counseling. If you’re interested, please email me and I’ll put the two of you in touch.
victoriatonikian · May 22, 2016 at 8:46 pm
I think that this example of physicians not offering or providing alternatives to SSRI’s to pregnant women follows directly in line with the current theme of medicating any possible problem. The society we live in is a very fast past-results sooner than later, society and because of this pills seem to be the easiest answer for some people. Rather than putting in effort and trying to solve issues without the use of pills, many people find it easier and like to see the results faster and thus opt for this option. I assume that there are many women who may need SSRI’s in order to function but i also think it is the responsibility of the medical community to make sure that those using SSRI’s have exhausted all other options. Will findings that this could be linked with birth defects in children, it is especially important to have a different mindset in the medical practice to ensure that SSRI’s are not just the easy way out.
Bcrowley712 · May 31, 2016 at 7:17 am
This is a very scary study for those who need SSRI’s: who have chemical imbalances that is biological and not environmental and those where CBT did not work. I am curious as to if Postpartum depression is more or less in women who use SSRIs during pregnancy. I hope that by the time I have children I am off of my SSRIs because I want to make sure I put as little amount of harmful substances into my child’s body as possible. It was mentioned to me that pharmaceutical companies will bribe physicians and psychiatrists to prescribe their medication even if it is not in the best interest of the patient, and this sickens me. SSRIs have been very difficult to get off of, and even though I know I do not plan to stay on them forever it has been a long process trying to carefully wean myself off of them while preventing as many symptoms as I can of withdrawal. But pregnant women cannot just stop taking the drug like one can stop drinking or smoking, because the withdrawal symptoms are so drastic that I imagine that would affect the baby as well. It saddens me that doctors are taking a more chemical way of fixing patients rather than trying holistic or more natural methods.
maddieadie · June 2, 2016 at 2:44 pm
It is definitely scary that over the past decades doctors have been increasingly more lenient with women taking medications during their pregnancy. I think part of the root of this problem is that modern medicine is pushing away holistic methods more and more. People are more focused on the quick fix now, especially ones that are easy to do. Thus taking medications before considering other options seems to be more and more common, which could also be influenced by doctors being paid more the more they prescribe meds. Overall, I have found that before taking a medication a doctor suggests, I try other methods. I know that talk therapy and cognitive-behavioral therapy can have the strongest and longest lasting effects on depression and anxiety disorders. I have also looked into essential oils as treatments for many ailments, from headaches and pain to skin issues.
RyanRobertson · June 2, 2016 at 4:37 pm
Unfortunately it seems as though in today’s society, medication will be encouraged sooner than ever before as a means to making money. I could be wrong, but cutting corners to make a buck seems to be a recurring theme in modern healthcare. I’ve always wondered why there aren’t more strict regulations for administering medication, especially with pregnant women or anyone with a situation in which drugs are not the most beneficial solution. Although I guess that’s the price we pay for the top notch medical professionals who need to be able to readily administer drugs when necessary.
bailey_arthur · June 2, 2016 at 7:49 pm
First of all, it is so sad that women feel guilt for having a child with special needs because there are a lot of misinformed, ignorant people who place them blame on the parents. However, I feel like this information about the risks SSRIs have on pregnancies. I feel like we leave in a country that pushes medication as a large solution to everything and arguably, especially in pregnancies. We have one of the highest rates of epidurals and inducing labor. Pregnant women’s pain are a large priority, which it should be; however, if women knew that relieving a short-term pain would come at the cost of long term mental aliments on their child it might change their mind. There should be no guilting or persuasion, but more information provided on the risks or other options. We should not push medicine because there are many safer and effective options for pregnant women. I feel like this stems from a deeper problem that pharmaceutical companies make large amounts of money pushing these medications to doctors, which should not be the case. I think medications should be a last resort for pregnant women like it used to be. I am glad that I know the risks of SSRIs because I intend on having children and will avoid any medications that I can.
Charlene Niku · December 5, 2016 at 5:45 pm
The question Dr. Freberg posed at the end of the post was what was going through my head while reading the article. “Why not encourage pregnant women to at least consider non-medication treatments for depression?” Considering there have been observed risks of taking SSRIs, I think that doctors should be more cautions when prescribing pregnant women medicine and perhaps recommending alternative treatments. It was interesting to read about how much can change in 30 years. It seems like nowadays, people take pills for a simple pains while pregnant women not too long ago, were advised not to take any medications, even for the most excruciating pain. I wonder what caused that change among physicians’ recommendations. It worries me that doctors have become so lenient over something so important and potentially life threatening – aside from SSRIs, other substances can seriously harm a baby. I also understand and feel sympathy for parents who have children will special needs because of the guilt that they shouldn’t but unfortunately do feel. I hope more research will be obtained in order to better educate the public and pregnant women especially regarding what is and isn’t okay to consume while expecting.
rachelcarlson · February 25, 2017 at 12:39 pm
Would the affects be the same with a stimulating antidepressant such as Bupropion, or could this type of medication potentially lead to other issues? I took a stimulating antidepressant for years because SSRIs were ineffective and had adverse side effects for me. It seems like a no-brainer that SSRIs would be a poor choice for pregnant women. What could have possibly caused a greater acceptance of such treatments for pregnant women from previous times?
Amy Edelstein · April 30, 2017 at 10:58 am
This was another interesting post that sparked my attention, as medication can be a controversial subject and people are sometimes fearful of bringing it up in conversation. Furthermore, this post was even more interesting to me as it involved the topic of pregnancy and medication – how mixing the two might result in negative consequences. I have always wondered if it was acceptable to take OTC medication while pregnant to treat minor issues like a headache or an upset stomach – medication like Advil or Tylenol. As discussed in this post, “the CDC reports that 90% of pregnant women take at least one medication…” This answers my lingering question: most pregnant women do rely on some sort of medication for any reason. However, we are all wondering if these medications have some sort of negative result? Do they harm the baby? Do they interfere with the development of the fetus? Do they block certain nutrients that are required for the baby to become a fully developed and healthy new-born? While some people, even pregnant women, rely heavily on certain medication like SSRIs to simply get them through a normal day, I think it is important to advertise other, non-medical alternatives to cure certain conditions. Instead of constantly taking Advil to ease a headache, people, especially pregnant women, should try meditating, applying essential oils, or sipping tea to cure any pain. There are other alternatives out there and they must be displayed for a wider audience!