Lugo-Candelas C, et al. - With the aid of structural and diffusion magnetic resonance imaging (MRI), authors scrutinized the correlation between prenatal selective serotonin reuptake inhibitor (SSRI) exposure and brain development at the Columbia University Medical Center and New York State Psychiatric Institute. It was discovered that prenatal SSRI exposure exhibited a link with fetal brain development, especially in brain regions critical to emotional processing. Since untreated prenatal maternal depression (PMD) presented as risks to both the infant and mother, the decision to initiate, continue, or suspend SSRI treatment persisted as a clinical dilemma.

Methods

• This research was performed at Columbia University Medical Center and New York State Psychiatric Institute.
• The enrollment consisted of 98 infants: 16 with in utero SSRI exposure, 21 with in utero untreated maternal depression exposure, and 61 healthy controls.
• Data extraction took place between January 6, 2011, and October 25, 2016.
• Selective serotonin reuptake inhibitors and untreated maternal depression were included as part of the exposures.
• The primary outcome included gray matter volume estimates using structural MRI with voxel-based morphometry and white matter structural connectivity (connectome) using diffusion MRI with probabilistic tractography.

Results

• A total of 98 mothers (31 [32%] white, 26 [27%] Hispanic/Latina, 26 [27%] black/African American, 15 [15%] other) and infants (46 [47%] boys, 52 [53%] girls) dyads were analyzed.
• It was determined that the mean (SD) age of the infants at the time of the scan was 3.43 (1.50) weeks.
• As per the Voxel-based morphometry, significant gray matter volume expansion was revealed in the right amygdala (Cohen d = 0.65; 95% CI, 0.06-1.23) and right insula (Cohen d = 0.86; 95% CI, 0.26-1.14) in SSRI-exposed infants compared with both healthy controls and infants exposed to untreated maternal depression (P < .05; whole-brain correction).
• The SSRI group demonstrated a substantial rise in connectivity between the right amygdala and the right insula with a large effect size (Cohen d = 0.99; 95% CI, 0.40-1.57) compared with healthy controls and untreated depression (P < .05; whole connectome correction) in connectome-level analysis of white matter structural connectivity.