Janecka M, et al. - The physicians studied the connection of early-life interference with various neurotransmitter systems by prenatal medication exposure on the risk of autism spectrum disorder (ASD) in children. In this research, it was concluded that most of the medications which affected the neurotransmitter systems were found in no relation with the assessments of ASD risk. It was also found that replication and/or validation using experimental techniques were also needed.

Methods

• In this case-control study, the investigators included the children who were born between January 1, 1997 and December 31, 2007, and were followed up for ASD till January 26, 2015, in a single health maintenance organization of Israel.
• In this sample, pregnant women who were given 55 groups of medications which could affect neurotransmitter systems were identified by using publicly available data.
• Children who were prenatally exposed to medications were then compared with those of nonexposed.
• They analyzed the data from March 1, 2017, through June 20, 2018.
• Main outcome and measures included hazard ratios (HRs) and 95% CIs of ASD risk were found linked to exposed medication groups using Cox proportional hazards regression, adjusted for the associated confounders (eg, birth year, maternal age, maternal history of psychiatric and neurologic disorders, or maternal number of all medical diagnoses 1 year before pregnancy).

Results

• A sum of 96,249 individuals (1,405 cases; 94,844 controls; mean [SD] age at the end of follow-up, 11.6 [3.1] years; 48.8% female), including 1,405 with ASD and 94,844 controls were involved in this study.
• Five out of 34 groups of medications showed minute statistically significant relations with ASD in fully adjusted models.
• Proof of confounding impacts of the number of maternal diagnoses on the association between children exposure to medication and ASD was found.
• After adjusting for this factor, the lower calculations of ASD risk among children exposed to cannabinoid receptor agonists (HR, 0.72; 95% CI, 0.55-0.95;P=.02), muscarinic receptor 2 agonists (HR, 0.49; 95% CI, 0.24-0.98;P=.04), opioid receptor κ and ε agonists (HR, 0.67; 95% CI, 0.45-0.99;P=.045), or α_2C-adrenergic receptor agonists (HR, 0.43; 95% CI, 0.19-0.96;P=.04) were recognized.
• It was also observed that exposure to antagonists of neuronal nicotinic acetylcholine receptor α was linked to higher estimates of ASD risk (HR, 12.94; 95% CI, 1.35-124.25;P=.03).