• Hilary K Brown, Neesha Hussain-Shamsy, Yona Lunsky, Dennis Cindy-Lee E CE Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada. , and Simone N Vigod.
• Women's College Research Institute, 76 Grenville Street, Toronto ON, Canada, M5S 1B2. hilary.brown@wchospital.ca.
• J Clin Psychiatry. 2017 Jan 1; 78 (1): e48-e58.

ObjectiveThis systematic review and meta-analysis examines the relationship between antenatal selective serotonin reuptake inhibitor (SSRI) exposure and child autism, with specific attention to maternal mental illness (MMI) as a potential confounding factor.Data SourcesWe searched MEDLINE, Embase, PsycINFO, and CINAHL from database inception to January 28, 2016.Study SelectionKeywords included terms for SSRIs, pregnancy, and autism. We included published, peer-reviewed articles written in English.Data ExtractionTwo reviewers used standardized instruments for data extraction and quality assessment. We generated pooled estimates for studies of the same design for SSRI exposure at any time during pregnancy and exposure during the first trimester. Subanalyses were conducted among studies with analyses (1) adjusted for MMI and (2) restricted to MMI.ResultsWe included in the meta-analysis 4 case-control studies and 2 cohort studies. In the case-control studies, the adjusted pooled odds ratio (aPOR) values were 1.4 (95% CI, 1.0-2.0) (any) and 1.7 (95% CI, 1.1-2.6) (first trimester). In MMI-adjusted analyses, only first trimester exposure remained statistically significant (aPOR = 1.8; 95% CI, 1.1-3.1). In MMI-restricted analyses, neither exposure period was statistically significant. In the cohort studies, MMI-adjusted relative risk values were 1.5 (95% CI, 0.9-2.7) (any) and 1.4 (95% CI, 1.0-1.9) (first trimester). In MMI-restricted analyses, SSRI exposure at any time during pregnancy was nonsignificant.ConclusionsIt remains unclear whether the association between first trimester SSRI exposure and child autism that was present in the case-control studies even after adjustment for MMI is a true association or a product of residual confounding. Future studies require robust measurement of MMI prior to and during pregnancy.© Copyright 2017 Physicians Postgraduate Press, Inc.

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