Association between maternal antidepressant use during pregnancy and autism spectrum disorder: an updated meta-analysis.
Xi-Hong Zhou, Yong-Jiang Li, Jian-Jun Ou and 1 others
PMID 29599960WHAT IT FOUND
Pooled cohort results found no significant association between maternal antidepressant use during pregnancy and autism spectrum disorder.
Case-control results looked positive, but after adjusting for possible publication bias they were not significant.
Key findings
01In pooled cohort studies (n = 2,839,980), the adjusted relative risk was 1.13 (95% CI 0.93 to 1.39), and the paper reported a non-significant association between prenatal antidepressant exposure and ASD.
02In pooled case-control studies (n = 117,737), the adjusted odds ratio was 1.51 (95% CI 1.15 to 1.99), a significant association; the filled estimate was 1.26 (95% CI 0.98 to 1.62), a non-significant association.
03After excluding case-control studies that did not include maternal psychiatric disorders as covariates, the pooled odds ratio was 1.41 (95% CI 1.00 to 1.99); cohort studies using sibling controls or controls of children exposed to maternal psychiatric disorder but no antidepressant use had a relative risk of 0.99 (95% CI 0.81 to 1.22).
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The evidence came from observational studies, and the paper says case-control studies were generally retrospective and unable to control for important confounding factors. Publication bias was suggested in both cohort and case-control studies, and the trim and fill adjusted estimates were estimated rather than retrieved. Only 14 studies were included, and two cohort studies had overlapping data sources. Some case-control studies did not include maternal psychiatric disorders as covariates, and the paper says residual confounding by maternal psychiatric disorders may be important. The paper did not report doses of antidepressant exposure or severity of ASD symptoms, and it lacked population-level, individual-specific data on depression and ASD.
The easy way to misread this
Do not read the significant case-control odds ratio of 1.51 as evidence of a causal association between antidepressant exposure and ASD. The case-control estimate changed to a non-significant filled odds ratio of 1.26 after publication-bias adjustment, and the cohort estimate was already non-significant.