Abstract | IMPORTANCE: OBJECTIVE: DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study. Health administrative data sets were used to study children born to mothers who were receiving public prescription drug coverage during pregnancy in Ontario, Canada, from 2002-2010, reflecting 4.2% of births. Children were followed up until March 31, 2014. EXPOSURES: MAIN OUTCOMES AND MEASURES: Child autism spectrum disorder identified after the age of 2 years. Exposure group differences were addressed by inverse probability of treatment weighting based on derived high-dimensional propensity scores (computerized algorithm used to select a large number of potential confounders) and by comparing exposed children with unexposed siblings. RESULTS: There were 35 906 singleton births at a mean gestational age of 38.7 weeks (50.4% were male, mean maternal age was 26.7 years, and mean duration of follow-up was 4.95 years). In the 2837 pregnancies (7.9%) exposed to antidepressants, 2.0% (95% CI, 1.6%-2.6%) of children were diagnosed with autism spectrum disorder. The incidence of autism spectrum disorder was 4.51 per 1000 person-years among children exposed to antidepressants vs 2.03 per 1000 person-years among unexposed children (between-group difference, 2.48 [95% CI, 2.33-2.62] per 1000 person-years; hazard ratio [HR], 2.16 [95% CI, 1.64-2.86]; adjusted HR, 1.59 [95% CI, 1.17-2.17]). After inverse probability of treatment weighting based on the high-dimensional propensity score, the association was not significant (HR, 1.61 [95% CI, 0.997-2.59]). The association was also not significant when exposed children were compared with unexposed siblings (incidence of autism spectrum disorder was 3.40 per 1000 person-years vs 2.05 per 1000 person-years, respectively; adjusted HR, 1.60 [95% CI, 0.69-3.74]). CONCLUSIONS AND RELEVANCE: In children born to mothers receiving public drug coverage in Ontario, Canada, in utero serotonergic antidepressant exposure compared with no exposure was not associated with autism spectrum disorder in the child. Although a causal relationship cannot be ruled out, the previously observed association may be explained by other factors.
|
Authors | Hilary K Brown, Joel G Ray, Andrew S Wilton, Yona Lunsky, Tara Gomes, Simone N Vigod |
Journal | JAMA
(JAMA)
Vol. 317
Issue 15
Pg. 1544-1552
(Apr 18 2017)
ISSN: 1538-3598 [Electronic] United States |
PMID | 28418480
(Publication Type: Journal Article)
|
Chemical References |
- Antidepressive Agents
- Serotonin Uptake Inhibitors
|
Topics |
- Adult
- Antidepressive Agents
(administration & dosage, adverse effects)
- Autism Spectrum Disorder
(chemically induced, epidemiology)
- Child, Preschool
- Drug Prescriptions
(statistics & numerical data)
- Female
- Humans
- Incidence
- Male
- Ontario
(epidemiology)
- Pregnancy
- Prenatal Exposure Delayed Effects
(chemically induced)
- Probability
- Propensity Score
- Retrospective Studies
- Selective Serotonin Reuptake Inhibitors
(administration & dosage, adverse effects)
- Siblings
|