12 May No link between Antidepressant use in Pregnancy and Autism? Great, but there’s also more to the story…
*I originally posted this article on LinkedIn, but also wanted to share here:
This article came out yesterday, and it immediately caught my eye. Prior studies that used case control samples analyzing large numbers of medical records had demonstrated an increased risk of autism with antidepressant exposure in utero. Therefore, this was one possible risk that I always discussed when talking with a woman who was considering taking an antidepressant during pregnancy.
However, this new study by Dr. Jeffrey Newport and his team found no link. This study is very reassuring to me, and I will now add it to my arsenal of research that I consider with my patients. Having worked on a systematic review for research before, I know that using meta-analytic technique (as done in this article) harnesses the power of multiple individual studies and can give us a more global picture into a medical issue.
What gave me pause, though, was the reason why this meta-analysis came up with a different outcome than some prior studies. The principal author, Dr. Jeffrey Newport, commented that “research failed to account for ascertainment bias, which occurs when one group of patients or subjects is tested more frequently than others.” What was going on?
The biggest factor in the end was ethnic bias. According to Dr. Newport, “In these studies, immigrant and Latina mothers consistently had both lower rates of antidepressant treatment and lower rates of autism diagnosis in their children,” Newport said. “This is not surprising, as these minority groups are known to have poorer access to health care, including treatment for depression and careful diagnostic assessment of concerning behaviors in a child.”
To address this, Dr. Newport’s group honed in on family based studies and reviewed them together. These studies looked at offspring in one family unit, and compared antidepressant exposure or autism in a child whose mother was taking an antidepressant during pregnancy and compared those rates to a sibling who was not exposed to an antidepressant. This essentially took out the ethnic bias. And once you took out the ethnic bias, the significant association between antidepressant use in pregnancy and autism went away.
It’s great that we have another piece of research that demonstrates a more reassuring safety profile for my pregnant patients who are trying to manage their depression or anxiety. But it’s also a good reminder for me to really think about and carefully review the details in the medical literature and fully understand how they apply to my patients. And to not miss the most important point, hopefully we will improve our systems so that everyone has an easier time to access care for their mental health needs, regardless of their ethnicity or immigrant status.