Invited Commentary: The Disillusionment of Developmental Origins of Health and Disease (DOHaD) Epidemiology. Issue 1 (2nd October 2019)

• Record Type: Journal Article
• Authors: Gilman, Stephen E; Hornig, Mady
• Is Part Of: American journal of epidemiology. Volume 189:Issue 1(2020)
• Page Start: 1
• Page End: 5
• Publication Date: 2019-10-02
• Subjects: acetaminophen -- attention deficit hyperactivity disorder -- autism spectrum disorder -- causality -- development -- meta-analysis -- pregnancy; Epidemiology -- Periodicals; Public health -- Periodicals; 614.4
• DOI: 10.1093/aje/kwz214
• Languages: English
• ISSNs: 0002-9262

Abstract

Abstract: The developmental origins of health and disease (DOHaD) model promises a greater understanding of early development but has left unresolved the balance of risks and benefits to offspring of medication use during pregnancy. Masarwa et al. ( Am J Epidemiol . 2018;187(8):1817–1827) conducted a meta-analysis of the association between in utero acetaminophen exposure and risks of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). A challenge of meta-analyzing results from observational studies is that summary measures of risk do not correspond to well-defined interventions when the individual studies adjusted for different covariate sets, which was the case here. This challenge limits the usefulness of observational meta-analyses for inferences about etiology and treatment planning. With that limitation understood, Masarwa et al. reported a 20%–30% higher risk of ADHD and ASD following prenatal acetaminophen exposure. Surprisingly, most of the original studies did not report diagnoses of ADHD or ASD. As a result, their summary estimates of risk are not informative about children's likelihood of ADHD and ASD diagnoses. The long-term promise of DOHaD remains hopeful, but more effort is needed in the short-term to critically evaluate observational studies suggesting risks associated with medications used to treat conditions during pregnancy that might have adverse consequences for a developing fetus.