Table 3.
Estimated univariate associations between ASD-related outcomes and prenatal antidepressant use, using child’s sex as the effect modification
| Associations (exposed vs. unexposed groups for outcomes) | Child’s sex | N | Coefficient/OR | LCL | UCL | P-value |
|---|---|---|---|---|---|---|
| SRS-2 total raw score, N=1346 | ||||||
| Any antidepressant | Male | 732 | 6.8 | −1.4 | 15.0 | 0.12 |
| Female | 607 | 5.8 | −3.5 | 15.1 | 0.30 | |
| Interaction | −1 | −11.8 | 9.8 | 0.12 | ||
| SSRI | Male | 664 | 7.2 | −2.6 | 17.0 | 0.19 |
| Female | 550 | 4.5 | −7.9 | 16.9 | 0.66 | |
| Interaction | −2.7 | −16.5 | 11.1 | 0.19 | ||
| Medical reported any antidepressant | Male | 70 | 15.6 | −17.8 | 49.0 | 0.51 |
| Female | 48 | 5.0 | −38.4 | 48.4 | 0.96 | |
| Interaction | −10.6 | −58.3 | 37 | 0.5 | ||
| Medical reported SSRI | Male | 71 | 20.5 | −18.1 | 59.0 | 0.42 |
| Female | 49 | 5.6 | −39.1 | 50.3 | 0.95 | |
| Interaction | −14.9 | −66.6 | 36.8 | 0.41 | ||
| Self-reported any antidepressant | Male | 662 | 5.6 | −2.7 | 13.8 | 0.25 |
| Female | 559 | 5.7 | −3.6 | 15.0 | 0.31 | |
| Interaction | 0.1 | −10.7 | 11 | 0.25 | ||
| Self-reported SSRI | Male | 593 | 5.3 | −4.5 | 15.2 | 0.40 |
| Female | 501 | 3.5 | −9.2 | 16.3 | 0.78 | |
| Interaction | −1.8 | −15.9 | 12.3 | 0.4 | ||
| CBCL DSM-5 ASP t-score for preschool children, N=1202 | ||||||
| Any antidepressant | Male | 653 | 1.1 | −1.2 | 3.5 | 0.49 |
| Female | 546 | 0.5 | −2.4 | 3.5 | 0.90 | |
| Interaction | −0.6 | −3.9 | 2.7 | 0.49 | ||
| SSRI | Male | 577 | 2.5 | −0.5 | 5.6 | 0.13 |
| Female | 495 | 1.4 | −2.5 | 5.4 | 0.66 | |
| Interaction | −1.1 | −5.5 | 3.3 | 0.13 | ||
| Medical reported any antidepressant | Male | 33 | −2.9 | −12.2 | 6.3 | 0.73 |
| Female | 26 | 3.5 | −3.4 | 10.4 | 0.45 | |
| Interaction | 6.4 | −3.7 | 16.5 | 0.73 | ||
| Medical reported SSRI | Male | 32 | −2.4 | −15.4 | 10.6 | 0.90 |
| Female | 26 | 3.5 | −3.4 | 10.4 | 0.45 | |
| Interaction | 5.9 | −7 | 18.8 | 0.9 | ||
| Self-reported any antidepressant | Male | 620 | 1.4 | −1.1 | 3.8 | 0.39 |
| Female | 520 | 0.2 | −3.0 | 3.3 | 0.99 | |
| Interaction | −1.2 | −4.7 | 2.3 | 0.39 | ||
| Self-reported SSRI | Male | 545 | 2.7 | −0.4 | 5.9 | 0.10 |
| Female | 469 | 1.0 | −3.7 | 5.7 | 0.86 | |
| Interaction | −1.7 | −6.7 | 3.2 | 0.1 | ||
| CBCL autism sum t-score for school-age children, N=546 | ||||||
| Any antidepressant | Male | 301 | 5.6 | −2.6 | 13.8 | 0.23 |
| Female | 245 | 4.2 | −4.7 | 13.1 | 0.50 | |
| Interaction | −1.4 | −12 | 9.2 | 0.23 | ||
| SSRI | Male | 268 | 1.4 | −8.5 | 11.3 | 0.94 |
| Female | 209 | 0.1 | −11.8 | 12.0 | 1.00 | |
| Interaction | −1.3 | −14.9 | 12.3 | 0.94 | ||
| Medical reported any antidepressant | Male | 44 | NA | NA | NA | NA |
| Female | 15 | NA | NA | NA | NA | |
| Interaction | NA | NA | NA | NA | ||
| Medical reported SSRI | Male | 44 | NA | NA | NA | NA |
| Female | 15 | NA | NA | NA | NA | |
| Interaction | NA | NA | NA | NA | ||
| Self-reported any antidepressant | Male | 257 | 6.5 | −1.5 | 14.6 | 0.14 |
| Female | 230 | 4.7 | −3.4 | 12.8 | 0.35 | |
| Interaction | −1.9 | −11.9 | 8.2 | 0.14 | ||
| Self-reported SSRI | Male | 224 | 1.9 | −8.2 | 12.1 | 0.89 |
| Female | 194 | 0.4 | −10.3 | 11.1 | 1.00 | |
| Interaction | −1.6 | −14.5 | 11.3 | 0.89 | ||
| ASD diagnosis, N=2384 | ||||||
| Any antidepressant | Male | 1304 | 1.1 | 0.4 | 3.0 | 0.94 |
| Female | 1073 | 1.5 | 0.3 | 8.8 | 0.85 | |
| Interaction | 1.3 | 0.2 | 7.7 | 0.94 | ||
| SSRI | Male | 1274 | 2.2 | 0.7 | 6.7 | 0.24 |
| Female | 1049 | 0.8 | 0.1 | 9.2 | 0.97 | |
| Interaction | 0.4 | 0.03 | 3.9 | 0.24 | ||
| Medical reported any antidepressant | Male | 325 | 1.1 | 0.3 | 4.2 | 0.98 |
| Female | 190 | 1.3 | 0.1 | 22.9 | 0.98 | |
| Interaction | 1.2 | 0.1 | 18.9 | 0.98 | ||
| Medical reported SSRI | Male | 321 | 2.4 | 0.4 | 14.7 | 0.51 |
| Female | 191 | 1.3 | 0.1 | 23.0 | 0.98 | |
| Interaction | 0.5 | 0.03 | 10.9 | 0.51 | ||
| Self-reported any antidepressant | Male | 979 | 1.2 | 0.3 | 5.0 | 0.93 |
| Female | 883 | 1.7 | 0.2 | 17.3 | 0.84 | |
| Interaction | 1.4 | 0.1 | 14.7 | 0.93 | ||
| Self-reported SSRI | Male | 953 | NA | NA | NA | NA |
| Female | 858 | NA | NA | NA | NA | |
| Interaction | NA | NA | NA | NA | ||
| M-CHAT-R/F, N=834 | ||||||
| Any antidepressant | Male | 451 | 1.5 | 0.3 | 6.7 | 0.80 |
| Female | 380 | 0.9 | 0.1 | 10.0 | 1.00 | |
| Interaction | 0.6 | 0.1 | 7.2 | 0.8 | ||
| SSRI | Male | 412 | NA | NA | NA | NA |
| Female | 349 | NA | NA | NA | NA | |
| Interaction | NA | NA | NA | NA | ||
| Medical reported any antidepressant | Male | 22 | NA | NA | NA | NA |
| Female | 20 | NA | NA | NA | NA | |
| Interaction | NA | NA | NA | NA | ||
| Medical reported SSRI | Male | 22 | NA | NA | NA | NA |
| Female | 20 | NA | NA | NA | NA | |
| Interaction | NA | NA | NA | NA | ||
| Self-reported any antidepressant | Male | 429 | 1.8 | 0.4 | 8.3 | 0.65 |
| Female | 360 | 1.4 | 0.1 | 15.8 | 0.94 | |
| Interaction | 0.8 | 0.1 | 9.3 | 0.65 | ||
| Self-reported SSRI | Male | 390 | NA | NA | NA | NA |
| Female | 329 | NA | NA | NA | NA | |
| Interaction | NA | NA | NA | NA | ||
ASD, autism spectrum disorder; CBCL, Child Behavior Checklist; LCL, lower confidence limit; M-CHAT-R/F, Modified Checklist for Autism in Toddlers-Revised with Follow-up; NA, not applicable; OR, odds ratio; SRS-2, Social Responsiveness Scale, Second Edition; SSRI, selective serotonin reuptake inhibitors; UCL, upper confidence limit
SRS-2 total raw score, CBCL DSM-5 Autism t-score, and CBCL autism sum t-score are continuous outcomes. The estimated coefficients of exposure are given in the third column. ASD diagnosis and M-CHAT-R/F are binary outcomes. The estimated OR for each binary outcome variable comparing the exposed and unexposed groups are given in the third column. NA represents that the corresponding model did not converge or the estimations were too extreme to be true.