The British Journal of Psychiatry
Prenatal exposure to selective serotonin reuptake inhibitors and social responsiveness symptoms of autism: population-based study of young children
Hanan El Marroun, Tonya J. H. White, Noortje J. F. van der Knaap, Judith R. Homberg, Guillén Fernández, Nikita K. Schoemaker, Vincent W. V. Jaddoe, Albert Hofman, Frank C. Verhulst, James J. Hudziak, Bruno H. C. Stricker, Henning Tiemeier
  • Declaration of interest

    F.C.V. is head of the Department of Child and Adolescent Psychiatry at Erasmus Medical Centre, which publishes the Achenbach System of Empirically Based Assessment (ASEBA) and from which the department receives remuneration.



Selective serotonin reuptake inhibitors (SSRIs) are considered safe and are frequently used during pregnancy. However, two case-control studies suggested an association between prenatal SSRI exposure with childhood autism.


To prospectively determine whether intra-uterine SSSRI exposure is associated with childhood autistic symptoms in a population-based study.


A total of 376 children prenatally exposed to maternal depressive symptoms (no SSRI exposure), 69 children prenatally exposed to SSRIs and 5531 unexposed children were included. Child pervasive developmental and affective problems were assessed by parental report with the Child Behavior Checklist at ages 1.5, 3 and 6. At age 6, we assessed autistic traits using the Social Responsiveness Scale (n = 4264).


Prenatal exposure to maternal depressive symptoms without SSRIs was related to both pervasive developmental (odds ratio (OR) = 1.44, 95% CI 1.07-1.93) and affective problems (OR = 1.44, 95% CI 1.15-1.81). Compared with unexposed children, those prenatally exposed to SSRIs also were at higher risk for developing pervasive developmental problems (OR = 1.91, 95% CI 1.13-3.47), but not for affective problems. Children prenatally exposed to SSRIs also had more autistic traits (B = 0.15, 95% CI 0.08-0.22) compared with those exposed to depressive symptoms only.


Our results suggest an association between prenatal SSRI exposure and autistic traits in children. Prenatal depressive symptoms without SSRI use were also associated with autistic traits, albeit this was weaker and less specific. Long-term drug safety trials are needed before evidence-based recommendations are possible.


  • Funding

    The Sophia Children’s Hospital Fund (SSWO-616) supported this work financially. The first phase of the Generation R Study was made possible by financial support from the Erasmus Medical Centre and The Netherlands Organization for Health Research and Development (Zon MW Geestkracht Program10.000.1003 & ZonMw TOP40-00812-98-11021, NWO Brain & Cognition Program Grant433-09-311 and VIDI Grant017.106.370).

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