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Prenatal Antidepressant Use and Risk of Autism Spectrum Disorders in Children

Prenatal Antidepressant Use and Risk of Autism Spectrum Disorders in Children To the Editor A media frenzy was caused by a JAMA Pediatrics article by Boukhris et al,1 which described an association between maternal exposure to antidepressant during pregnancy and autism spectrum disorder (ASD) in their offspring. Although the published article was very careful not to imply causality, its Abstract stated that the “use of antidepressants during the second and/or third trimester increases the risk of ASD in children,”1 which is misleading. Press releases and interviews further implied causality and the need to switch to other treatment options in pregnant women, although the risks of untreated depression during pregnancy were acknowledged.1,2 The study was well crafted and methodologically sound, but its interpretation raised some important issues. First, preexisting literature on the association of ASD with maternal exposure to antidepressants is far from black and white. A 2015 review article concluded that “there is more convincing evidence that antidepressants do not cause ASD than convincing evidence that it does.”3 However, Boukhris et al1 stated in their discussion that “taken together, these studies are suggestive of an increased risk of ASD associated with use of antidepressants during pregnancy.” This is quite a leap and could have been addressed to greater lengths. Their results do not provide a final answer. Although some authors have also detected an association between maternal antidepressant use and ASD in children, most of these findings identified the first trimester as the most at-risk period, whereas Boukhris et al only found significant results in the second and third trimesters.1,4 They justified these findings by stating that the critical phase of brain development occurs from the second to third trimesters. However, the authors seemed to overlook that indication bias may be a significant issue because women with more severe depressive symptoms are more likely to continue antidepressant use throughout their pregnancy. Indeed, severe maternal depression has been suggested as a risk factor for autism.5 In conclusion, caution should always be exerted when reporting and interpreting new results, be it in the scientific papers or the mainstream media. If not, good science may lead to adverse consequences and unnecessary panic, especially when concerning sensitive topics in vulnerable populations. Back to top Article Information Corresponding Author: Pascal Bédard, BPharm, MSc, Sainte-Justine University Hospital Center, Department of Pharmacy, 3175 ch. de la Côte-Sainte-Catherine, Montréal, QC H3T 1C5, Canada (pascal.bedard.hsj@ssss.gouv.qc.ca). Published Online: May 31, 2016. doi:10.1001/jamapediatrics.2016.0730. Conflict of Interest Disclosures: None reported. Disclaimer: The author has the same affiliation (Sainte-Justine Hospital) as some authors of the article by Boukhris et al. Mr Bédard has never worked with nor collaborated with any of the authors of that article. References 1. Boukhris T, Sheehy O, Mottron L, Bérard A. Antidepressant use during pregnancy and the risk of autism spectrum disorder in children. JAMA Pediatr. 2016;170(2):117-124.PubMedGoogle ScholarCrossref 2. Université de Montréal. Taking antidepressants during pregnancy increases risk of autism by 87% [news release]. http://www.nouvelles.umontreal.ca/udem-news/news/20151214-taking-antidepressants-during-pregnancy-increases-risk-of-autism-by-87.html. Accessed January 6, 2016. 3. Robinson GE. Controversies about the use of antidepressants in pregnancy. J Nerv Ment Dis. 2015;203(3):159-163. doi:10.1097/NMD.0000000000000256.PubMedGoogle ScholarCrossref 4. Croen LA, Grether JK, Yoshida CK, Odouli R, Hendrick V. Antidepressant use during pregnancy and childhood autism spectrum disorders. Arch Gen Psychiatry. 2011;68(11):1104-1112. doi:10.1001/archgenpsychiatry.2011.73.PubMedGoogle ScholarCrossref 5. Clements CC, Castro VM, Blumenthal SR, et al. Prenatal antidepressant exposure is associated with risk for attention-deficit hyperactivity disorder but not autism spectrum disorder in a large health system. Mol Psychiatry. 2015;20(6):727-734. doi:10.1038/mp.2014.90.PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Pediatrics American Medical Association

Prenatal Antidepressant Use and Risk of Autism Spectrum Disorders in Children

JAMA Pediatrics , Volume 170 (7) – Jul 1, 2016

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References (1)

Publisher
American Medical Association
Copyright
Copyright © 2016 American Medical Association. All Rights Reserved.
ISSN
2168-6203
eISSN
2168-6211
DOI
10.1001/jamapediatrics.2016.0730
Publisher site
See Article on Publisher Site

Abstract

To the Editor A media frenzy was caused by a JAMA Pediatrics article by Boukhris et al,1 which described an association between maternal exposure to antidepressant during pregnancy and autism spectrum disorder (ASD) in their offspring. Although the published article was very careful not to imply causality, its Abstract stated that the “use of antidepressants during the second and/or third trimester increases the risk of ASD in children,”1 which is misleading. Press releases and interviews further implied causality and the need to switch to other treatment options in pregnant women, although the risks of untreated depression during pregnancy were acknowledged.1,2 The study was well crafted and methodologically sound, but its interpretation raised some important issues. First, preexisting literature on the association of ASD with maternal exposure to antidepressants is far from black and white. A 2015 review article concluded that “there is more convincing evidence that antidepressants do not cause ASD than convincing evidence that it does.”3 However, Boukhris et al1 stated in their discussion that “taken together, these studies are suggestive of an increased risk of ASD associated with use of antidepressants during pregnancy.” This is quite a leap and could have been addressed to greater lengths. Their results do not provide a final answer. Although some authors have also detected an association between maternal antidepressant use and ASD in children, most of these findings identified the first trimester as the most at-risk period, whereas Boukhris et al only found significant results in the second and third trimesters.1,4 They justified these findings by stating that the critical phase of brain development occurs from the second to third trimesters. However, the authors seemed to overlook that indication bias may be a significant issue because women with more severe depressive symptoms are more likely to continue antidepressant use throughout their pregnancy. Indeed, severe maternal depression has been suggested as a risk factor for autism.5 In conclusion, caution should always be exerted when reporting and interpreting new results, be it in the scientific papers or the mainstream media. If not, good science may lead to adverse consequences and unnecessary panic, especially when concerning sensitive topics in vulnerable populations. Back to top Article Information Corresponding Author: Pascal Bédard, BPharm, MSc, Sainte-Justine University Hospital Center, Department of Pharmacy, 3175 ch. de la Côte-Sainte-Catherine, Montréal, QC H3T 1C5, Canada (pascal.bedard.hsj@ssss.gouv.qc.ca). Published Online: May 31, 2016. doi:10.1001/jamapediatrics.2016.0730. Conflict of Interest Disclosures: None reported. Disclaimer: The author has the same affiliation (Sainte-Justine Hospital) as some authors of the article by Boukhris et al. Mr Bédard has never worked with nor collaborated with any of the authors of that article. References 1. Boukhris T, Sheehy O, Mottron L, Bérard A. Antidepressant use during pregnancy and the risk of autism spectrum disorder in children. JAMA Pediatr. 2016;170(2):117-124.PubMedGoogle ScholarCrossref 2. Université de Montréal. Taking antidepressants during pregnancy increases risk of autism by 87% [news release]. http://www.nouvelles.umontreal.ca/udem-news/news/20151214-taking-antidepressants-during-pregnancy-increases-risk-of-autism-by-87.html. Accessed January 6, 2016. 3. Robinson GE. Controversies about the use of antidepressants in pregnancy. J Nerv Ment Dis. 2015;203(3):159-163. doi:10.1097/NMD.0000000000000256.PubMedGoogle ScholarCrossref 4. Croen LA, Grether JK, Yoshida CK, Odouli R, Hendrick V. Antidepressant use during pregnancy and childhood autism spectrum disorders. Arch Gen Psychiatry. 2011;68(11):1104-1112. doi:10.1001/archgenpsychiatry.2011.73.PubMedGoogle ScholarCrossref 5. Clements CC, Castro VM, Blumenthal SR, et al. Prenatal antidepressant exposure is associated with risk for attention-deficit hyperactivity disorder but not autism spectrum disorder in a large health system. Mol Psychiatry. 2015;20(6):727-734. doi:10.1038/mp.2014.90.PubMedGoogle ScholarCrossref

Journal

JAMA PediatricsAmerican Medical Association

Published: Jul 1, 2016

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