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Obstetrical Providers’ Preferred Mode of Delivery and Attitude Toward Nonmedically Indicated Caesarean Sections: A Cross-Sectional Study

selected for full review. Six relevant cohort studies met inclusion criteria. Four studies were conducted in Europe, 1 in Canada, and 1 in China. All studies were found to be of high quality. The meta-analysis found a significant association between antidepressant exposure during pregnancy and the risk of ADHD in children [HR, 1.34; 95% confidence interval (CI), 1.14-1.57]; though, there was significant heterogeneity amongst the studies. The exposure was significant regardless if the exposure occurred in the first trimester (HR, 1.39; 95% CI, 1.30-1.48) or during the second or third trimester (HR, 1.37; 95% CI, 1.18-1.60). Three studies were used for analysis of preconception antidepressant use and found an increased risk of ADHD in offspring (HR, 1.82; 95% CI, 1.54-2.15). However, in 2 studies, the association was not statistically significant when the reference group consisted of mothers with psychiatric disorders not receiving treatment during pregnancy (HR, 0.96; 95% CI, 0.76-1.2). In summary, this meta-analysis of 6 studies found that antidepressant use during pregnancy may be associated with an increased risk of ADHD in children, even when limited to preconception use. However, the rate of ADHD in children exposed to antidepressants was not different than the rate in children of mothers with psychiatric illness who did not use antidepressants. Therefore, the association may have been overestimated as studies often do not control for maternal psychiatric status as a confounding factor. Future prospective studies should use validated measurements of ADHD and consider the severity of maternal psychiatric disease.