Controversies involving the use of SSRIs during pregnancy and the increased risk of having a child with autism spectrum disorders – a case report and literature review

Summary Introduction: There is an ongoing debate as to whether the use of selective serotonin reuptake inhibitors (SSRIs) by pregnant women increases the risk of developing autism spectrum disorders (ASD) in the offspring. Aim: The aim of the study was to 1) present, based on a case report, the potential factors that may affect the development of ASD in a child, 2) review the literature on the risk of ASD in the case of using SSRIs by a pregnant woman. Case report: The case report concerns a child of a 33-year-old patient, previously treated for an episode of depression at the age of 23. At the beginning of the 15th week of planned pregnancy, when she was 28 years old, sleep disturbances were observed. Over the next few weeks, she gradually developed a full-blown depressive syndrome which required the use of sertraline. The child was born through a natural delivery, a healthy boy, who was diagnosed with ASD at the age of 2.5 years, which was the trigger for the development of the third episode of depression in the patient. Conclusions: The results of the research indicate that SSRIs can penetrate the placental barrier, influencing the processes of serotoninergic transmission in the fetus, disrupting neurodevelopmental processes. On the other hand, a higher risk of ASD development in children of depressed mothers who do not use pharmacotherapy was confirmed, compared to the general population and in the case of the occurrence of depressive episodes in mother in the past and in relation to the male fetuses. The greater risk of ASD in children of mothers who take SSRIs may not only be associated with the medication itself but also with the presence of depression and the probable common genetic basis for both disorders. In each case, other risk factors for the development of ASD should also be taken into consideration, e.g. vitamin D3 deficiencies, unsaturated fatty acids, oxytocin levels, the presence of intestinal dysbiosis.