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Originally published by 2 Minute Medicine® (view original article). Reused on AccessPediatrics with permission.

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1. Paternal use of SSRIs before conception was associated with a slightly increased risk of attention-deficit/hyperactivity disorder (ADHD) in offspring.

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2. Paternal underlying indications related to selective serotonin reuptake inhibitor (SSRI) use may explain this increased risk.

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Evidence Level: 2 (Good)

Study Rundown:

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Prenatal SSRI exposure has been associated with offspring neuropsychiatric diagnoses including autism and ADHD. Despite evidence from animal studies, few human-based research projects have evaluated how paternal SSRI use may impact this risk. Using retrospective data from the Danish national registers, researchers in the current study explored the potential association between paternal SSRI use and offspring ADHD.

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Study authors found that children whose fathers took an SSRI within the 3 months before conception had a slightly increased risk of ADHD compared to controls. The study also found that children whose fathers took an SSRI from 12 months to 3 months before conception, but not in the 3 months before conception, had a similarly slightly increased risk of ADHD. Therefore, the results suggest that paternal SSRI use is associated with an increased risk of ADHD in offspring, but that paternal mental illness, may explain risk of ADHD in children whose fathers use SSRIs in the pre-conception period. The major limitations of this study included an inability to assess other risk factors in fathers that could contribute to ADHD in offspring, and to examine the specificity of the findings to ADHD. This study is consistent with previous studies that show an observed link between paternal psychiatric history and child ADHD.

In-Depth [retrospective cohort]:

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Researchers reviewed data from several Danish national registries, which included a total of 781 470 singleton births in the analyzed window. Cox regression models were used to estimate hazard ratios of ADHD risk given paternal SSRI exposure. A child was considered “exposed” if the father had an active SSRI prescription filled within 3 months before conception of a child.

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Compared to an unexposed group, fathers of exposed children were more likely to be older than 35 and have a history of psychiatric and affective disorders, and mothers had higher parity, were more likely to use antidepressants, and have a psychiatric history. After adjusting forcovariates including sex, birth weight, APGAR scores, gestation age, parental ages, and parental psychiatric history the adjusted hazard ratio (aHR) of ADHD in the 3-month exposed group was 1.26 (95%CI 1.23-1.74) compared to no SSRI use in the 3 months before conception. A second analysis examined children whose fathers took an SSRI between 12 and 3 months, but not in the immediate 3 months, before conception. In this group, the aHR of ADHD in offspring was 1.35 (95%CI 1.10-1.66) compared to children whose fathers did not take an SSRI in the 12 months before conception.

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