Valproate use during pregnancy was linked to autism spectrum disorder and childhood autism in offspring

摘要

The robust observational cohort study by Christensen and colleagues provides timely and relevant information about the association between maternal use of valproate during pregnancy and the occurrence of autism spectrum disorder and childhood autism. Study strengths include long duration of follow-up and careful control of both fetal and parental confounding factors. Potential study limitations include the possibility of selection bias and inability to control for unmeasured confounding factors (1). When interpreting data on fetal risks associated with maternal valproate use, clinicians should take into account not only the point estimate but also evaluate the upper bounds of the hazard ratio (1). After adjusting for several parental and fetal characteristics, Christensen and colleagues reported a 2.9-fold increased risk for autism spectrum disorder and a 5.2-fold increased risk for childhood autism. The upper bounds of the confidence intervals indicate that 5-fold increases for autism spectrum disorder and 10-fold increases for childhood autism are within the bounds of reasonable probability. These data add weight to evidence in support of a causal association between valproate and child neurodevelopment outcomes (2, 3).