Use of Selective Serotonin Reuptake Inhibitors during Pregnancy and Risk of Autism

Autism and its causes have been a heavily discussed issue.  This study specifically concerns the issue of the use of antidepressants during pregnancy and increased risk of autism spectrum disorders.  The study was conducted in Denmark and looked at live births from 1996 to 2005.  It looked at the use of SSRIs by the mother before and during pregnancy, autism spectrum disorders that were diagnosed and any other potential confounders.

The results of the study showed that there was no increased risk of autism spectrum disorders associated with use of SSRIs during pregnancy when compared to no SSRI use both before and during pregnancy.  While no significant association could be found, based on the upper boundary of the confidence interval relative risk of up to 1.61 could exist.  Therefore, the study concluded that more research had to be conducted to determine a conclusive answer.

I found this article interesting because of how much attention is being paid to autism and its potential causes.  I think it is extremely important to always do your research before making a claim or even sharing an article on Facebook.  So many people are willing to accept inaccurate information, especially if its explains something in their life that was previously unexplainable.

Hviid A, Melbye M, and Pasternak B. Use of Selective Serotonin Reuptake Inhibitors during Pregnancy and Risk of Autism. N Engl J Med. 2013;369(25): 2406-415.

http://www.nejm.org/doi/full/10.1056/NEJMoa1301449

In utero Exposure to β-2-Adrenergic Receptor Agonist Drugs and Risk for Autism Spectrum Disorders

Autism Spectrum Disorders (ASD) have received much media attention regarding supposed links between them and childhood vaccines. While this association is false, there may be evidence to support an association between maternal use of B-2-adrenergic receptor (B2AR) agonists and child development of ASD. Previous studies support a correlation between the two, but they do not show whether the drug or the mother’s condition is causal. Evidence on the mechanism of B2AR agonists also supports the association between their use and ASD.

Researchers from Drexel University sought to further research a possible link between B2AR agonist drugs and ASD by performing a case-control study on children born in Denmark between 1997 and 2006. Cases were considered to be any children diagnosed with childhood autism, atypical autism, Asperger syndrome, and pervasive developmental disorder- unspecified, while controls were considered anyone without these diagnoses. Ten controls were matched with each case based on birth month and year, so in total there were 5,200 cases and 52,000 controls. Children were considered exposed to B2AR agonists if there was maternal use any time between 90 days before the estimated conception date and the delivery date.

The study found that 3.7% of cases were exposed to B2AR agonists and 2.9% of controls were exposed to B2AR agonists during pregnancy. Thus, the researchers concluded that exposure to B2AR agonists during pregnancy was associated with an increased risk for ASD and that the risk was similar for exposure in the first, second, and third trimesters. However, less than 1% of cases of ASD could be attributed to the exposure to B2AR agonists, if their use is in fact a cause of ASD.

This study interested me because it looked into a potential correlation between autism and medications that I have not heard of previously. I am curious to see whether articles like this one will have as large of an impact on media portrayals of autism and its causes as the false article on the causal relationship between autism and vaccines has had. I am also interested in seeing if this research has any effect on the use of B2AR agonists in pregnant women or if the benefits of the medication always outweigh the risks to the child.

 Pediatrics. 2016; 137 (2): 1-8.

Prescription Use Among Children with Autism Spectrum Disorders

The purpose of this article is to focus on the difference between prescription medications given to children with autism spectrum disorders versus children in the general population. Published in February 2016, this article focuses on a study that was conducted during the years 2007-2010. This study was a cross-sectional study of ambulatory prescription fills from Maine, Vermont and New Hampshire.

Autism Spectrum Disorders, or ASDs, affect more children than we may think. In fact, during this study, there were 13,100 children diagnosed with ASD, compared to the 936,721 children without ASD diagnosis. That means that about 1 in every 71 children is diagnosed with ASD. Also, along with the ASD diagnosis comes prescription medications. Furthermore, this study showed that children with ASDs consume more prescription drugs than the general pediatric population.

The overall prescription fill rate was about 4-fold higher in children with ASD compared to the children without ASD. First, psychotropic use among children with ASD was 9-fold higher than the general population rate. The children with ASD made up about 2% of the pediatric population, but received a little over 15% of the psychotropics being prescribed to those pediatric patients. Next, nonpsychotropic drug use was also higher in the population with ASD, particularly in those children age 3 or younger. Furthermore, antibiotic use was 2-fold higher and antacid use was nearly 5-fold higher than the general population.

This increase in drug use was not only observed in the community settings, but also seen in the hospital settings. Antacid and alpha-agonist uses in hospital settings were about 3-fold higher in the ASD population, and benzodiazepines reached nearly 4-fold higher for the ASD population in the hospital setting.

As you can see, autism spectrum disorders really affect the medication use in the pediatric population. There is an overall increase in psychotropic and nonpsychotropic prescription medications in the ASD population, followed by an increase in other prescription drugs as well. There is still more research to be done in this category; however, the correlation is shown relating ASD with prescription drug use as compared to the general population.

Prescription Use among Children with Autism Spectrum Disorders in Northern New England: Intensity and Small Area Variation. House, Samantha A. et al. The Journal of Pediatrics , Volume 169 , 277 – 283.e2

http://www.jpeds.com/article/S0022-3476(15)01199-3/fulltext