Source: Heinonen EW, Kao K, Mattson SN, et al. Cognitive outcomes of children exposed to selective serotonin reuptake inhibitors through breast milk. JAMA Netw Open. 2025;8;(11):e2544989; doi: 10.1001/jamanetworkopen.2025.44989.Investigators from the University of California, San Diego, and San Diego State University conducted a retrospective study to evaluate the association between exposure to selective serotonin reuptake inhibitors (SSRIs) and cognitive outcomes in children exposed to SSRIs during pregnancy. For the study, they reviewed data in the MotherToBaby California cohort in which pregnant women voluntarily enrolled. Data on the mothers and their offspring were collected, including cognitive testing on some children during preschool years. Participants in the current study were children in the cohort born between 1989 and 2008, prenatally exposed to SSRIs, who underwent IQ testing with the Wechsler Primary and Preschool Test of Intelligence (WPPSI) when they were 4–5 years old. Data collected on these children included demographics, type and duration of SSRI prenatal exposure, whether or not they were breastfed and, if breastfed, whether their mother continued SSRI while breastfeeding. Study participants were assigned to 1 of 3 groups: breastfed and exposed to SSRI, breastfed with no SSRI postnatal exposure, and not breastfed. The main outcomes were full scale IQ (FSIQ), verbal IQ (VIQ), and performance IQ (PIQ), based on WPPSI assessments when study children were 4–5 years old. Outcomes were compared between participants who were in the SSRI-exposed breastfeeding group and those breastfed but not exposed, and in those breastfed and exposed and children not breastfed in separate analyses, after adjusting for age, sex, and history of prematurity.Data were analyzed on 97 children, with 22 exposed to SSRIs while breastfed, 37 breastfed without postnatal exposure to SSRIs, and 38 not breastfed. The mean duration of prenatal exposure to SSRIs was 24.2 ±15.6 weeks; 81 (83.5%) mothers of study children were treated with fluoxetine hydrochloride during pregnancy. The mean age of participants at cognitive testing was 4.9 years. The adjusted mean FSIQ in children exposed to SSRI when breastfed was 109.4, compared to 106.1 in those breastfed but not exposed (P = 0.29) and 103.1 in those not breastfed (P = 0.046). There was no significant difference in PIQ among those breastfed who were exposed or unexposed to SSRI (adjusted mean, 112.3 vs 106.7; P = 0.12), but PIQ was significantly higher in breastfed and SSRI-exposed participants than in those not breastfed (adjusted mean, 104.2; P = 0.03). There was no significant difference in VIQ between children in the breastfed and SSRI exposed group (adjusted mean, 105.3) and those breastfed but not exposed (104.3; P = 0.89) or those not breastfed (102.8; P = 0.54).The authors conclude that, among children prenatally exposed to SSRI, additional exposure through breastfeeding was not associated with impaired cognitive development at 4–5 years of age.Dr Badawi has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The American Academy of Pediatrics recommends exclusive breastfeeding for at least 6 months,1 noting rare medical contraindications. Since 2015, the Academy of Breastfeeding Medicine clinical guideline has recommended continued use of SSRIs while breastfeeding due to the long-term negative outcomes of maternal depression on mothers and children.2 Despite these recommendations, women taking chronic medications without a known contraindication for breastfeeding are less likely to exclusively breastfeed.3The current researchers address this important issue by comparing the impact of SSRIs (primarily fluoxetine) use during breastfeeding on preschool developmental outcomes. The mean IQ scores in all 3 groups (breastfed with SSRI exposure, breastfed without exposure, and not breastfed) were in the solidly average range. There was significant overlap in scores among the groups, but the performance IQ specifically was higher among the breastfed children. It was notable that women who stopped their SSRIs had a much shorter duration of breastfeeding than those who continued them, and those on other medications in addition to SSRIs were less likely to breastfeed.The authors acknowledge that the modest sample size of their study is a limitation. However, studies examining the impact of both breastfeeding and maternal depression on child development are key to supporting lactation. This is important from a public health perspective given the health benefits consistently confirmed by the literature.4Breastfeeding has a positive impact on child cognitive development, while maternal depression impacts development negatively. Current knowledge indicates that mothers taking SSRIs should be encouraged to continue these and to breastfeed while doing so.
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