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Editor's Note
April 19, 2021

More on Epidurals and Autism

Author Affiliations
  • 1Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
  • 2Editor, JAMA Pediatrics
JAMA Pediatr. 2021;175(7):705. doi:10.1001/jamapediatrics.2021.0385

This is only the second time I have penned an Editor’s Note, and it is occasioned by the first time we have published 2 similar studies that have reached different conclusions within a single 12-month period. Searching for an explanatory modifiable risk for autism is an elusive goal with very important and far-reaching public health implications, given its large and growing prevalence. Because there will never be experimental studies of environmental exposures, we are left with imperfect observational studies that are always at risk for residual confounding, especially when observed effect sizes are small as they are likely to be in this case even if they are real. The study by Qui et al1 generated considerable press and many respondents rightly pointed out that residual confounding may explain the observed association between epidurals and autism. Wall-Weiler et al2 used a similar approach with more robust design features and found no association. Science is an imperfect and iterative process, and our responsibility as journal editors is to manage the process as best we can. Publishing 2 conflicting studies in such a short time frame serves as testament that we recognize the process for what it is. Hanley et al3 do an excellent job of putting the conflicting studies into context and suggesting a way forward. For now, my personal assessment is that the association is yet to be definitively established. If a more definitive study is done, JAMA Pediatrics will publish it.

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