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Comment & Response
June 2017

Influenza Vaccination in the First Trimester of Pregnancy and Risk of Autism Spectrum Disorder—Reply

Author Affiliations
  • 1Division of Research, Kaiser Permanente Northern California, Oakland
JAMA Pediatr. 2017;171(6):601-602. doi:10.1001/jamapediatrics.2017.0737

In Reply We appreciate the comments presented by Donzelli and colleagues and Hooker about our study titled “Association Between Influenza Infection and Vaccination During Pregnancy and Risk of Autism Spectrum Disorder.”1 Statisticians and epidemiologists have debated at length whether this type of epidemiologic study should adjust for multiple testing, and no consensus has been reached.2-4 We used the conservative Bonferroni adjustment following suggestions received from JAMA Pediatrics reviewers. We agree with Donzelli et al and Hooker that the 3 trimesters are not independent of the entire pregnancy period. However, a less-conservative adjustment for multiple testing, accounting for the dependence of the entire pregnancy on the trimesters, would still yield a P value of .07 or higher, which should not change interpretations of our findings.