Absence of evidence for increase in risk for autism or attention-deficit hyperactivity disorder following antidepressant exposure during pregnancy: a replication study.

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TitleAbsence of evidence for increase in risk for autism or attention-deficit hyperactivity disorder following antidepressant exposure during pregnancy: a replication study.
Publication TypeJournal Article
Year of Publication2016
AuthorsCastro, VM, Kong, SW, Clements, CC, Brady, R, Kaimal, AJ, Doyle, AE, Robinson, EB, Churchill, SE, Kohane, IS, Perlis, RH
JournalTransl Psychiatry
Volume6
Paginatione708
Date Published2016 Jan 05
ISSN2158-3188
KeywordsAdolescent, Adult, Antidepressive Agents, Attention Deficit Disorder with Hyperactivity, Autistic Disorder, Causality, Child, Child, Preschool, Depressive Disorder, Female, Humans, Male, Pregnancy, Prenatal Exposure Delayed Effects, Risk Factors, Young Adult
Abstract

Multiple studies have examined the risk of prenatal antidepressant exposure and risk for autism spectrum disorder (ASD) or attention-deficit hyperactivity disorder (ADHD), with inconsistent results. Precisely estimating such risk, if any, is of great importance in light of the need to balance such risk with the benefit of depression and anxiety treatment. We developed a method to integrate data from multiple New England health systems, matching offspring and maternal health data in electronic health records to characterize diagnoses and medication exposure. Children with ASD or ADHD were matched 1:3 with children without neurodevelopmental disorders. Association between maternal antidepressant exposure and ASD or ADHD liability was examined using logistic regression, adjusting for potential sociodemographic and psychiatric confounding variables. In new cohorts of 1245 ASD cases and 1701 ADHD cases, along with age-, sex- and socioeconomic status matched controls, neither disorder was significantly associated with prenatal antidepressant exposure in crude or adjusted models (adjusted odds ratio 0.90, 95% confidence interval 0.50-1.54 for ASD; 0.97, 95% confidence interval 0.53-1.69 for ADHD). Pre-pregnancy antidepressant exposure significantly increased risk for both disorders. These results suggest that prior reports of association between prenatal antidepressant exposure and neurodevelopmental disease are likely to represent a false-positive finding, which may arise in part through confounding by indication. They further demonstrate the potential to integrate data across electronic health records studies spanning multiple health systems to enable efficient pharmacovigilance investigation.

DOI10.1038/tp.2015.190
Alternate JournalTransl Psychiatry
PubMed ID26731445
PubMed Central IDPMC5068870
Grant ListR01MH086026 / MH / NIMH NIH HHS / United States
5 K23 MH100623 / MH / NIMH NIH HHS / United States
1P50MH106933 / MH / NIMH NIH HHS / United States
5R01MH100286-02 / MH / NIMH NIH HHS / United States
R01 MH107205 / MH / NIMH NIH HHS / United States
2U54LM008748 / LM / NLM NIH HHS / United States
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