(P-579) Prenatal Exposure to Psychotropic Medications and the Risk of Seizure in Children: A Population-based Cohort Study

Background: The risk of seizures in children with prenatal psychotropic medication exposure is unclear.

Objectives: To evaluate the association between prenatal exposure to antidepressants/antipsychotics and the risk of seizure in children.

Methods: Setting: A population-based cohort study was conducted using data from the Hong Kong Clinical Data Analysis and Reporting System. Pregnant women aged between 15 and 50 years old who delivered a live birth between 2001 to 2015 were included. Children were followed up until 2016.
Exposures: Antidepressant or antipsychotic use during pregnancy. Pregnancy episode with both antipsychotics and antidepressants were removed.
Main outcome measures: Seizure in children.
Statistical analysis: Hazard ratios (HRs) with a 95% confidence interval (CI) were evaluated to assess the association between antidepressant/antipsychotic use during pregnancy and seizure in children using propensity score fine-stratification weighting, Cox proportional hazards regression model and sibling-matched analysis.

Results: Among 414,076 mother-child pairs identified, 412,817 and 410,609 children were included in the antidepressants and antipsychotics analyses respectively. 2,205 (0.53%) and 616 (0.15%) were exposed to antidepressants and antipsychotics respectively during pregnancy. 17,879 (4.33%) and 17,753 (4.32%) children were diagnosed with seizure at any time during follow-up (mean: antidepressant: 6.59 years; antipsychotics: 6.60 years). Children with prenatal antidepressant/antipsychotics exposure were associated with an increased risk of seizure, compared to those without (weighted HR [wHR] antidepressants: 1.25; 95% CI 1.03-1.50; antipsychotics: 1.52; 95% CI 1.14-2.03). A similar increase was found in the comparison between children of mothers who had used antidepressants/antipsychotics before but not during pregnancy and never users (wHR antidepressants: 1.32; 95% CI 1.14-1.52; antipsychotics: 2.10, 95% CI 1.69-2.62). Sibling-matched analysis indicated no significant difference between the risk of seizure and the use of antidepressants/antipsychotics during pregnancy (wHR antidepressants: 1.00; 95% CI 0.45-2.23; antipsychotics: 1.29, 95% CI 0.21-7.72).

Conclusions: Our findings suggest that the association between prenatal exposure to antidepressants or antipsychotics and the risk of seizure in offspring might be explained by confounding. Women should discuss their individual cases with clinicians to decide whether use of antidepressants/antipsychotics in pregnancy is indicated and that potential benefits outweigh the risks.