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Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: population based case-control study

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2059 (Published 19 April 2013) Cite this as: BMJ 2013;346:f2059

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Re: Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: population based case-control study

The authors concluded, based upon 9 cases and 27 controls, that there is a 3.34-fold increase in risk of autism among children whose depressed mothers took antidepressant medications. They purported to adjust the raw association for "history of psychiatric disorders other than depression, parental ages, income, education, occupation, migration status, and parity." While it is mathematically possible to make such a statistical adjustment, the result is essentially meaningless. There are too many variables, not enough cases. The authors should have acknowledged that they were unable to control their study for confounding variables, due to limited sample size, and therefore, the observed association was not established as causal. Further research in larger studies is required in order to determine whether or not a robust, causal association exists between maternal antidepressant use and autism. The association observed in this study is necessarily tentative, and the weakness of evidence should be taken into account when women and their physicians make decisions about pharmacotherapy of depression during pregnancy.

Competing interests: No competing interests

23 April 2013
Thomas Morgan
Physician
Vanderbilt University
DD-2205 MCN, Nashville, TN 37232-2578