Do Prenatal Tdap Vaccines Increase Risk for Autism?
BACKGROUND AND PURPOSE:
Becerra-Culqui et al. (Pediatrics, 2018) examined the association between prenatal tetanus, diphtheria, acellular pertussis (Tdap) vaccination and autism spectrum disorder (ASD)
Retrospective cohort study
Mother-child pairs, members in an integrated healthcare system (15 hospitals/approximately 4.4 members)
Restricted to live singleton infants 22 to 45 weeks’ gestation
Mothers had to be members from start of pregnancy | Infants had to be members for at least 90 days after 1st birthday
Maternal Tdap vaccination from pregnancy start to delivery date obtained from electronic medical records
Children were managed from birth to first ASD diagnosis, end of membership, or end of follow-up (3 years)
Adjustments were made for
Child’s birth year | Gestational age at birth (<37 or ≥37 wk) | Maternal age, race and/or ethnicity, and education | Medicaid insurance | Medical center of delivery | Parity | Start of prenatal care | Flu vaccine during pregnancy
Primary outcome was diagnosis of autism spectrum disorder (ASD)
12-month minimum for ASD diagnosis based on Autism Diagnostic Observation Schedule (Gold Standard diagnostic instrument)
81,993 children included in the study
Prenatal Tdap vaccination
26% for the 2012 birth cohort to 79% for the 2014 birth cohort
Mean age of vaccination: 28 weeks to 29 weeks, respectively
1341 children were diagnosed with ASD
The ASD incidence rate was
3.78 per 1000 person years in the Tdap exposed group
4.05 per 1000 person years in the unexposed group
Adjusted HR 0.85; 95% CI 0.77-0.95 demonstrated no association with increased risk for ASD
Prenatal Tdap vaccination is not associated with increased risk of ASD
Minimal change in results with respect to parity or year of birth
The authors state
We provide evidence supporting the ACIP’s recommendation to vaccinate pregnant women to protect vulnerable infants, who are at highest risk of hospitalization and death after pertussis infection.
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