Association of maternal depression and antidepressant use during pregnancy with child allergic risk: A nationwide cohort study.

PURPOSE: Whether maternal depression or antidepressant use during pregnancy increases the risk of allergic diseases in offspring remains unclear. Hence, in this study, these associations were assessed in a large, nationwide cohort in Taiwan.

METHODS

This population-based cohort study used Taiwanese birth certificate and health insurance claims data, encompassing 2743,735 live births between 2004 and 2020. Mothers were classified into three groups: no depression and no antidepressant use (non-DEP), depression without antidepressant use (DEP-ATD), and depression with antidepressant use (DEP+ATD). Offspring were followed for the presence of atopic dermatitis, allergic rhinitis, and asthma. Adjusted hazard ratios (aHRs) were estimated using Cox models controlling for parental, perinatal, and medication-related factors.

RESULTS

In unadjusted analyses, maternal depression without antidepressant use was associated with higher risks of atopic dermatitis (HR = 1.15), allergic rhinitis (HR = 1.16), and asthma (HR = 1.12) in offspring (p < 0.001 for all). However, after adjustment, these associations were no longer statistically significant (e.g., for atopic dermatitis: aHR = 1.06, 95% CI = 0.99-1.15). Among mothers with depression, antidepressant use was not associated with higher risks than no antidepressant use (e.g., atopic dermatitis: aHR = 1.01, 95% CI = 0.93-1.10).

CONCLUSION

In summary, after adjustment for measured confounders, no statistically significant association between maternal depression and offspring allergic disease risk was observed in the primary analysis, although a small association cannot be excluded. Among mothers with depression, antidepressant use during pregnancy was not associated with a higher risk of allergic diseases in offspring compared with no antidepressant use. These findings may inform individualized risk-benefit discussions regarding antidepressant treatment during pregnancy.