#63 In-Utero SSRI and SNRI Exposure and the Risk of Autism Spectrum Disorder in Children: A Population-Based Retrospective Cohort Study Utilizing Linked Administrative Data
Deepa Singal, Manitoba Centre for Health Policy; Marni Brownell, Manitoba Centre for Health Policy; Dan Chateau, Manitoba Centre for Health Policy; Laurence Katz, University of Manitoba; Ruth Chelsea, University of Manitoba; Elizabeth Wall-Wieler, University of Manitoba; Ana Hanlon-Dearman, University of Manitoba
Previous studies have demonstrated an association between the risk of autism spectrum disorder (ASD) in children and exposure in utero to serotonergic antidepressants. However, these studies are limited by confounding by history of maternal depression, disease severity and the use of limited populations of women affecting generalizability of results. This study addresses the limitations of previous studies by using a population-based sample of women diagnosed with mood and anxiety disorder, thus restricting our analysis to patients for whom pharmacotherapy is clearly indicated.
Using population-level linked administrative data from a universal health care system, this study included all mother-newborn pairs in Manitoba (born 1996 to 2009, with follow-up through 2014). High Dimensional Propensity Scores and inverse probability treatment weighting were used to address confounding by indication and disease severity. The final trimmed cohort consisted of mothers who had a mood/anxiety disorder diagnosis between 90 days prior to conception until delivery (n = 4,995); 16.8% had at least two dispensations of an SSRI or SNRI during pregnancy. Cox Proportional Hazard Regression models were used to estimate risk of ASD in offspring.
Use of SSRIs/SNRIs during pregnancy was not associated with an increased risk of ASD: HR 0.92 (95% CI 0.42 to 2.03).
In a large population level sample, in utero exposure to serotonergic antidepressants compared with no exposure does not increase risk of ASD among children of women who have prenatal mood/anxiety disorder.