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Tim F. Oberlander, MD, FRCPC; Pratibha Reebye, MD, FRCPC; Shaila Misri, MD, FRCPC; Michael Papsdorf, PhD; John Kim, PhD; Ruth E. Grunau, PhD

Arch Pediatr Adolesc Med. 2007;161(1):22-29.

Objective  To evaluate attentional and activity behaviors in 4-year-olds following prenatal selective serotonin reuptake inhibitor (SSRI) exposure.

Design  Prospective cohort design.

Setting  Tertiary care center.

Participants  Twenty-two 4-year-olds with prolonged prenatal SSRI medication exposure and 14 children without prenatal exposure.

Main Exposure  Prenatal SSRI exposure.

Main Outcome Measures  Group differences in externalizing behaviors (according to the Child Behavior Checklist) and direct observations of child attention, activity, and impulsiveness in a laboratory setting using the procedure by Crowell and colleagues were compared, including measures of the duration of prenatal SSRI exposure, umbilical cord drug levels, a history of poor neonatal adaptation, and maternal mood.

Results  Externalizing behaviors did not differ between groups. Maternal depression and anxiety at the 4-year follow-up were associated with increased reports of externalizing behaviors. Increased externalizing behaviors were associated with increased umbilical cord drug levels (F_1,34 = 6.3; P = .02), but when controlling for maternal depressed mood at the 4-year follow-up, such levels only accounted for 11.2% of the behavioral outcomes (P>.05). On direct observation, the persistence score for child behavior was significantly lower in the exposed group. Increased aggressiveness scores were associated with a history of poor neonatal adaptation, even when parental report of stress was added to the model (F_1,34 = 4.0; P = .03); however, neither parental report of stress nor poor neonatal adaptation were significant (both P = .09), suggesting that both are important, if not unique, predictors of child behavior.

Conclusions  These findings suggest that the best predictors of externalizing behaviors at age 4 years are current maternal mood and parental stress, regardless of prenatal depressed mood and SSRI treatment during pregnancy. It remains uncertain whether poor neonatal adaptation can be excluded as a possible predictor of externalizing behaviors.

Author Affiliations: Department of Pediatrics, Human Early Experience Unit, Centre for Community Child Health Research, Research Institute for Children's and Women's Health (Drs Oberlander, Papsdorf, and Grunau), and Child Psychiatry (Dr Reebye) and Reproductive Mental Health Program (Dr Misri), Department of Psychiatry, University of British Columbia, Vancouver, British Columbia; and College of Pharmacy, Sungkyunwan University, Seoul, South Korea (Dr Kim).

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