No Association Between Antidepressant Use During Pregnancy, Child’s Risk for Autism-Related Traits

No Association Between Antidepressant Use During Pregnancy, Child's Risk for Autism-Related Traits

Authors: Patricia Brennan, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

What were the study results?

This study found that prenatal use of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), did not increase a child’s risk for ASD or related traits.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

Pregnant women who are diagnosed with depression must weigh a number of risks when making decisions about treatments. Sometimes medical providers may recommend treatment with antidepressants. This study suggests that maternal use of antidepressants, including SSRIs, during pregnancy does not increase a child’s risk for autism-related traits. This information can be valuable in helping pregnant women and their physicians decide whether antidepressant treatment is right for them.

Why was this study needed?

Previous studies have reported mixed findings on the relationship between prenatal antidepressant use and child autism. Pregnant women and the physicians that treat them need more data to inform their decisions about whether to take certain medications during pregnancy.

Who was involved?

This study included 3,129 mothers and their children enrolled in ECHO cohorts across the United States. Participants provided data on prenatal exposure to antidepressants as well as measures of autism-related traits collected when the child was between 1 and 12 years of age. About 5% of the participating mothers took antidepressants during pregnancy.

What happened during the study?

The researchers used medical records and maternal self-reports to determine what medicines mothers used during pregnancy. Mothers reported on whether their child received an autism spectrum disorder (ASD) diagnosis and also completed rating scales about their child’s behavior, including social, language, and other traits related to autism.

What happens next?

Future studies might consider whether the dose or timing of antidepressant use during pregnancy changes its effect on child health outcomes.

Where can I learn more?

Access the full journal article, titled “Prenatal Antidepressant Exposures and Autism Spectrum Disorder or Traits: A Retrospective, Multi-Cohort Study,” in Research on Child and Adolescent Psychopathology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published November 22, 2022

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No Association Between Antidepressant Use During Pregnancy, Child's Risk for Autism-Related Traits

ECHO Study Identifies Depression, Anxiety, and Other Drug Use as Risk Factors for Opioid Use During Pregnancy

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ECHO Study Identifies Depression, Anxiety, and Other Drug Use as Risk Factors for Opioid Use During Pregnancy

Authors: Ruby H.N. Nguyen, Monica McGrath, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

What were the study results?

Most of the participants who used opioids were non-Hispanic White and had at least some college education. Opioid use was more common among people who used tobacco or illegal drugs, and those with a history of depression or anxiety. Additionally, opioid use during pregnancy in this study was rare—only 2.8% of participants used opioids during pregnancy, and the majority of opioid use originated from a prescription.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This is among the largest observational studies of opioid use during pregnancy thus far, and the diverse sample of pregnant participants is more representative of the U.S. population than previous studies. Results from this study strengthened evidence about the co-occurrence of opioid use in pregnancy with depression and use of multiple substances (such as tobacco and illegal drugs). These findings will help to inform further research on screening tools for opioid use during pregnancy. Additionally, the finding that most opioid use originated from prescriptions reinforces the need to reduce the amount of circulating prescription drugs and to better monitor over-prescription of opioids to pregnant women and provide them with alternative treatment solutions for pain management and opioid dependency.

Why was this study needed?

Opioids are a class of drugs used as prescription pain relievers that can cause dependence or addiction. The opioid crisis has disproportionately affected women, and use of these drugs can have detrimental effects on women of reproductive ages and on developing fetuses. Previous studies of opioid use during pregnancy have been limited to individuals in specific geographic locations or those with specific types of insurance. The stigmatization of this population has also complicated the collection of data on maternal opioid use during pregnancy. Using a large sample size, this study examined opioid use in a diverse population of pregnant women across the United States to investigate rare exposures – such as polysubstance use - and characteristics associated with opioid use during pregnancy.

Who was involved?

This study included over 20,000 pregnant participants from 32 ECHO cohorts across the U.S., creating a large and geographically diverse sample.

What happened during the study?

The researchers gathered data from pregnant women who were already participants in ECHO cohorts between 1991 and 2021. Medical records, laboratory tests, and self-reports were used to assess opioid use and potentially related factors, such as demographics, use of other substances, and history of anxiety or depression.

What happens next?

This study shows that further research is needed on the factors that may lead to use of multiple substances during pregnancy and the association between substance use and depression. This research can help inform the development of screening tools and procedures for identifying individuals who are potentially at risk for opioid use during pregnancy.

Where can I learn more?

Access the full journal article, titled “Characteristics of Individuals in the U.S. who Used Opioids during Pregnancy,” in the Journal of Women’s Health.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published November 9, 2022

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ECHO Study Identifies Depression, Anxiety, and Other Drug Use as Risk Factors for Opioid Use During Pregnancy

ECHO Study Compares Cross-Cultural Patterns of Attention Linked to Underlying Behavior Problems in Children

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ECHO Study Compares Cross-Cultural Patterns of Attention Linked to Underlying Behavior Problems in Children

Authors: Sara Nozadi, Andréa Aguiar, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

What were the study results?

Patterns of attention were similar across the two groups of children despite the differences in their cultures, demographics, or assessment settings. Overall, children paid more attention to emotional faces compared to neutral faces. They were particularly quick to identify angry faces, which might be an adaptive response to a perceived threat. These findings replicate previous research results with both adults and children.

Indigenous children with socially withdrawn behaviors avoided emotional faces—a response observed in children with higher levels of socially withdrawn behaviors from other populations.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This work suggests that eye tracking can be used as an objective measure of attention patterns in children across different settings and cultures, which can help researchers and clinicians more reliably identify children with early behavior problems. Because eye tracking technology does not rely on clinical observations or parents’ reports, it can be used as an unbiased measure across different communities to validate data collected through clinical assessments and parent reports in hard-to-reach communities.

Why was this study needed?

Humans tend to give more attention to emotional information than neutral information. Past research indicates departures from this pattern typically occur in children with socially withdrawn behaviors. However, this research is limited because it has been conducted mostly in controlled settings among primarily White children from urban areas.

In this study, ECHO researchers examined the extent to which two eye-tracking–based measures could be used cross-culturally to assess attention biases and how these biases might relate to children’s socially withdrawn behaviors.

Who was involved?

To evaluate whether eye-tracking technology could be applied effectively across cultures, researchers compared information from two ECHO cohorts that were very different demographically, geographically, racially, and culturally.

The researchers analyzed data from 125 children from the Navajo Birth Cohort Study, a cohort of indigenous children with relatively low socioeconomic status (SES) living in rural tribal lands, and 70 children from the Illinois Kids Development Study (IKIDS), a primarily Non-Hispanic White and high-SES cohort living around the University of Illinois at Urbana-Champaign campus in central Illinois.

What happened during the study?

Children between the ages of 3.5 years to 5.5 years completed two eye-tracking tasks that measured their attention to photos of human faces with positive, negative, and neutral expressions. Indigenous children were assessed in different locations in the Navajo territory, whereas IKIDS children came to a research laboratory in the University campus. Mothers also reported on children’s socially withdrawn behaviors, such as avoiding eye contact, using the Child Behavioral Checklist—a survey commonly used in research and clinical settings to evaluate risk for behavioral and emotional problems in children.

What happens next?

The researchers will look at how the responses they see in these young children change with age and determine whether eye tracking continues to be an unbiased tool for assessing attention throughout development.

Where can I learn more?

Access the full journal article titled “Cross-Cultural Applicability of Eye-Tracking in Assessing Attention to Emotional Faces in Preschool-Aged Children” published in the Emotion Journal.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published: September 15, 2022

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ECHO Study Compares Cross-Cultural Patterns of Attention Linked to Underlying Behavior Problems in Children

ECHO Study Identifies Biological, Behavioral, and Social Factors Affecting Pregnancy Health

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ECHO Study Identifies Biological, Behavioral, and Social Factors Affecting Pregnancy Health

Authors: Stephanie Eick, Rachel Morello-Frosch, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

What were the study results?

Pregnant participants who were over 30 years old and had a college degree had lower levels of oxidative stress. Levels of oxidative stress were higher among pregnant participants who were overweight or obese and unmarried. Also, current smokers or those with less than a high school education had higher levels of a oxidative stress biomarker. These results help identify how social, biologic, and behavioral factors may contribute to poor health in mothers and children.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This is the largest study to date looking at the relationship between biological, social, and behavioral factors and oxidative stress during pregnancy. The results of this study provide important clues into how socioeconomic inequalities can contribute to poor health in pregnant women. This study may also inform future studies looking at risk factors for preterm birth.

Why was this study needed?

There is little data on what can cause oxidative stress during pregnancy. Oxidative stress is a process that can trigger cell damage and it is thought to play a role in the development of some diseases. By identifying biological, behavioral, and socioeconomic factors in a mother’s day-to-day life that may lead to increased risk for oxidative stress, research can help inform the development of targeted strategies for the prevention of poor prenatal health outcomes.

Who was involved?

This study involved approximately 2,000 pregnant participants in the mainland United States and Puerto Rico who were enrolled in one of four ECHO cohorts.

What happened during the study?

Researchers collected urine samples from participants and measured the levels of biomarkers for oxidative stress. Researchers calculated how levels of oxidative stress biomarkers changed in response to biological, behavioral, and social factors. Maternal age, pre-pregnancy body mass index, marital/partnered status, parity, and smoking status were included as biological and behavioral factors while race/ethnicity, maternal education, and stressful life events were considered social factors.

What happens next?

The research team is examining the impact of oxidative stress on adverse pregnancy outcomes, such as preterm birth.

Where can I learn more?

The full journal article, titled “Associations between social, biologic, and behavioral factors and biomarkers of oxidative stress during pregnancy: Findings from four ECHO cohorts” is published in Science of the Total Environment.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published April 29, 2022

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ECHO Study Identifies Biological, Behavioral, and Social Factors Affecting Pregnancy Health

ECHO Study Suggests Link Between Smoking During Pregnancy and Autism-Related Traits in Children

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ECHO Study Suggests Link Between Smoking During Pregnancy and Autism-Related Traits in Children

Authors: Rashelle J. Musci, Irva Hertz-Picciotto, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

What were the study results?

Smoking before or during pregnancy was consistently associated with ASD traits, such as symptoms of social impairments. Additionally, babies born at full term had a somewhat higher risk of receiving an ASD diagnosis as a child if their mothers smoked before or during the pregnancy.

More counseling is needed for pregnant women or those planning a pregnancy to help them understand how these potential risks for the child’s behavioral development add to other poor outcomes associated with smoking during pregnancy, such as low birthweight, increased likelihood of fetal or infant death, asthma in early childhood, or attention deficit hyperactivity disorder (ADHD).

Footnote: Results reported here represent results from 11 or seven studies, depending on the outcome. Other or future studies may provide new information or different results. Consult your healthcare professional for guidance on how to limit your unborn child’s exposure to tobacco smoke. However, please also note that you have a greater chance of improving your child’s health and their social and behavioral development the sooner you quit or reduce smoking.

What was the study's impact?

There are many reasons for women to limit their exposure to tobacco smoke during pregnancy—tobacco smoke increases risk for low birthweight, ectopic pregnancy, a premature delivery, or fetal/infant death. Less research has been done to learn how tobacco smoke can influence children’s health, although studies have linked prenatal smoking to higher childhood asthma and ADHD risk. This study shows how prenatal exposure to cigarette smoke may also harm a child’s social development. Social skills can be important for success in school and getting along with others. Doctors, child educators, and other health and daycare providers should also know that children exposed to prenatal cigarette smoke may also be at higher risk for developing ASD.

Why was this study needed?

Previous studies provide varying results on how tobacco smoke exposure during pregnancy may affect risk for autism spectrum disorder (ASD) in children. Exposures to air pollution, which has many of the same chemicals as tobacco smoke but at lower levels, have also been linked with ASD. ASD is a complex condition that involves not only trouble in social interactions but also communication problems and patterns of repetitive behaviors or narrow interests.

The research team set out to conduct a study with participants from across the U.S. that could clear up inconsistencies found in previous research. Additionally, no other research has looked at the relationship between maternal tobacco smoking and milder autism-like symptoms of social impairment.

Who was involved?

Researchers studied approximately 11,000 children in 13 cohorts around the U.S. who either had a diagnosis of ASD, social impairment measurable on the Social Responsive Scale, or both. There also had to be information on exposure to prenatal smoking and other factors that could influence the study results.

What happened during the study?

Researchers pulled together and analyzed results from each cohort related to maternal smoking behaviors before or during pregnancy and childhood ASD diagnosis or ASD-related social impairment. The team took specific actions to prevent other factors related to the children and mothers from affecting the quality and consistency of the data.

What happens next?

Future studies can help researchers identify when babies are most at-risk to cigarette smoke exposure and how other factors associated with prenatal smoking may contribute to negative health outcomes.

Where can I learn more?

Access the full journal article, titled “Maternal Tobacco Smoking and Offspring Autism Spectrum Disorder or Traits in ECHO Cohorts” in Autism Research.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published February 24, 2022

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ECHO Study Suggests Link Between Smoking During Pregnancy and Autism-Related Traits in Children

ECHO Study Suggests Exposure to Opioids During Pregnancy May Have Subtle Effects on Child Health Outcomes

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ECHO Study Suggests Exposure to Opioids During Pregnancy May Have Subtle Effects on Child Health Outcomes

Author(s): Elisabeth Conradt, Sheila Crowell and Barry Lester

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

What were the study results?

We were not able to learn what the short and long-term results of prenatal opioid exposure were because of the limitations with the existing information. Our best working hypothesis is that the effects of prenatal opioid exposure at birth and in infancy are small and subtle, but that the effects may grow as children age and have more demands on their attention at home and at school.

What was the study's impact?

We are still trying hard to learn about the short and long-term developmental effects of prenatal opioid exposure. We think that the effects of prenatal opioid exposure at birth and in infancy are subtle, and that they could be also be caused by the effects of other things such as poverty and early life stress. The effects in childhood may be stronger, but they could also be due to long-term stress exposure. More high-quality research is needed to answer the question, “how does prenatal opioid exposure affect the child?”

Why was this study needed?

We have very little information about how a mother’s use of opioids during pregnancy (prenatal opioid exposure) can affect child development. The information we have thus far is limited by not having many people to study and not being able to study other factors that may have an effect on child development, such as poverty. For this study, we reviewed what information we know so far and also made suggestions for how to improve knowledge of prenatal opioid exposure.

Who was involved?

This publication was a review of information that had already been published. After review, we came together as a group and decided what should be done next to answer the question, “how does prenatal opioid exposure affect the child?”

What happened during the study?

We reviewed over 50 studies to try to come up with some answers about how being exposed to opioids during pregnancy affects a child over short and long periods of time. We then discussed the limitations of the study and developed a list of what can be done in the future to fix these limitations. We concluded by describing how ECHO can help provide more information about this research topic.

What happens next?

We will use the ECHO data that are already collected to test how prenatal opioid exposure affects knowledge/understanding, behavior, and attention span in middle childhood. We will consider other possible factors such as poverty. We will also look at whether newborns who have Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome (NAS/NOWS) have worse effects compared to newborns exposed to opioids who do not have NAS/NOWS.

Where can I learn more?

Access the full journal article, titled "Early life stress and environmental influences on the neurodevelopment of children with prenatal opioid exposure," published in Neurobiology of Stress.

Visit NIDA’s website to learn more about opioid use and prenatal opioid exposure: https://www.drugabuse.gov/drugs-abuse/opioids

Access the Harvard Center on the Developing Child website to understand how to reduce the negative effects of early life stress exposure: https://developingchild.harvard.edu/

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published: August 15, 2018

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ECHO Study Suggests Exposure to Opioids During Pregnancy May Have Subtle Effects on Child Health Outcomes