Objective
Antidepressants, mostly selective serotonin reuptake inhibitors (SSRI), are widely used during gestation. Recently, antidepressants were shown to increase the risk of autism spectrum disorders (ASD). Although in Boukhris et al the risk of ASD was more prevalent among women exposed to SSRI during the second/third trimester, no data were available for specific SSRIs nor was family history considered. This study aims to quantify the risk of ASD associated with the use of specific SSRIs in a birth cohort. Stratified analyses on family history are also presented.
Study Design
Using the same study cohort as Boukhris et al, within the Quebec Pregnancy Cohort, we defined antidepressant exposure as having at least 1 prescription filled during the second/third trimester of pregnancy. Combined antidepressant use was defined as the filling of prescriptions for at least 2 different antidepressant types. The reference category was infants who were not exposed to antidepressants at any time throughout gestation. We identified all children with a diagnosis of ASD between birth and the end of follow-up, which was the date of the event (index date: ASD), death (censoring), or the end of the study period (Dec. 31, 2009; censoring), whichever occurred first. Family history was defined as having a sibling with ASD. Similarly to Boukhris et al, 4 categories of potential confounders were considered: maternal sociodemographic characteristics; history of maternal psychiatric conditions (based on International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases, 10th Revision codes); maternal chronic conditions (based on International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases, 10th Revision codes and medication use); and infant characteristics. First-trimester exposure to antidepressants was also considered. Trend analyses on antidepressants, maternal depression/anxiety, and ASD were performed using Cochran-Armitage trend test. Crude and adjusted hazard ratios with 95% confidence intervals (CI) were calculated using Cox proportional hazard regression models. Stratified analyses were performed on family history of ASD. The CHU Sainte-Justine Ethics Committee approved this study.
Study Design
Using the same study cohort as Boukhris et al, within the Quebec Pregnancy Cohort, we defined antidepressant exposure as having at least 1 prescription filled during the second/third trimester of pregnancy. Combined antidepressant use was defined as the filling of prescriptions for at least 2 different antidepressant types. The reference category was infants who were not exposed to antidepressants at any time throughout gestation. We identified all children with a diagnosis of ASD between birth and the end of follow-up, which was the date of the event (index date: ASD), death (censoring), or the end of the study period (Dec. 31, 2009; censoring), whichever occurred first. Family history was defined as having a sibling with ASD. Similarly to Boukhris et al, 4 categories of potential confounders were considered: maternal sociodemographic characteristics; history of maternal psychiatric conditions (based on International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases, 10th Revision codes); maternal chronic conditions (based on International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases, 10th Revision codes and medication use); and infant characteristics. First-trimester exposure to antidepressants was also considered. Trend analyses on antidepressants, maternal depression/anxiety, and ASD were performed using Cochran-Armitage trend test. Crude and adjusted hazard ratios with 95% confidence intervals (CI) were calculated using Cox proportional hazard regression models. Stratified analyses were performed on family history of ASD. The CHU Sainte-Justine Ethics Committee approved this study.
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