New York—Prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) is associated with fetal brain development, especially in regions essential for emotional processing, according to a new study.

The report in JAMA Pediatrics, which calls for further research on the potential long-term behavioral and psychological outcomes of the neurodevelopmental changes, suggests that the finding is especially important because SSRI use has increased among pregnant women.

The Columbia University Medical Center–led research team posits that usage of the drugs might be on an upswing because of an increased awareness about the adverse effects of untreated prenatal maternal depression on women and children.

Background information in the article notes that although not much is known about the association between prenatal SSRI and fetal neurodevelopment in humans, animal studies have hinted that perinatal SSRI exposure can alter brain circuitry and produce anxiety and depressive-like behaviors after adolescence.

To try to determine the effects, the researchers focused on 98 infant-mother pairs between 2011 and 2016; 16 infants who had in-utero SSRI exposure self-reported by mothers were compared with 21 infants exposed in utero to untreated maternal depression and 61 other healthy infants without those exposures.

The study team looked at SSRIs and untreated maternal depression, using magnetic resonance imaging (MRI) to estimate gray-matter volume and white matter structural connectivity.

Results were that voxel-based morphometry showed significant gray matter volume expansion in the right amygdala (Cohen d = 0.65; 95% CI, 0.06-1.23) and right insula (Cohen d = 0.86; 95% CI, 0.26-1.14) in SSRI-exposed infants versus both healthy controls and infants exposed to untreated maternal depression.

In addition, in connectome-level analysis of white matter structural connectivity, the SSRI group showed a significant increase in connectivity between the right amygdala and the right insula with a large effect size (Cohen d = 0.99; 95% CI, 0.40-1.57) compared with healthy controls and untreated depression, researchers report.
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