Treated and untreated maternal prenatal mental health difficulties and neurodevelopmental outcomes in early childhood: results from the ELFE cohort

Objective: To assess the impact of prenatal psychotropic medication use on children’s neurodevelopmental outcomes. Design: Prospective observational study Setting: Maternity clinics Population: ELFE birth cohort (N=18,329) children who were unexposed to maternal mental health difficulties during pregnancy (MHD) (n=15,519), exposed to MHD (n=1,980), or exposed to prenatal psychotropic use (PPU) (n=242) Methods: Mothers reported their MHD and PPU at birth and covariates were collected at birth, two months, and one year postpartum. Inverse probability weighting based on multinomial propensity scores adjusted for a wide range of perinatal, socioeconomic, partner and healthcare system support, and family history confounders. Potential moderation by child sex, maternal education, and migration background was tested. Main Outcomes: Child Autistic traits were evaluated at 2 years using the Modified Checklist for Autism in Toddlers (M-CHAT) and general development at ages 3.5 and 5.5 years was evaluated using the Child Development Inventory (CDI). Results: PPU exposure was not associated with children’s M-CHAT, while MHD Exposure without PPU was significantly associated in both crude and weighted regressions. At 3.5 years, crude models showed lower CDI scores for children of MHD Exposed and PPU-exposed mothers compared with unexposed children, but all associations became non-significant after weighting. No significant effects, across CDI subscales, were observed at age 5.5 years, nor in moderation analyses. E-values suggested results were highly sensitive to residual confounding. Conclusions : We found limited evidence for clinically meaningful associations between prenatal psychotropic medication exposure and early child neurodevelopment after accounting for various maternal, household, socio-economic, and family history confounders.