Response to JAMA Pediatrics paper on the association of prenatal ultrasonography and autism spectrum disorder by the ISUOG Safety Committee, published 12 Feb 2018

Read the full ISUOG Safety Statement

Dr Christoph Lees' comment on the JAMA Pediatrics paper:

“This modest sized retrospective study purports to show a relationship between prenatal ultrasound and autism. Women should be reassured that it shows no link at all between duration of ultrasound exposure and autism, nor between ultrasound energy used and autism.

One problem with the study design is that the authors don't tell us 'up front' what the key comparisons they are looking for are. The authors choose many comparisons including an invented and previously unknown index: time weighted mean depth of ultrasound. They don't describe this time-weighted mean depth of ultrasound index - as a group of clinicians and scientists closely involved in all aspects of ultrasound safety we have no idea what they are describing. In short, this ultrasound index has no obvious scientific or biological justification.

Further, the authors have not corrected for their many comparisons: you don't have to be a statistician to know that if you toss a coin enough times you're bound to get a result you are looking for.

In summary, autism and prenatal ultrasound are both really contentious areas that easily lead to unwarranted alarm for women and false messages. This study, if read carefully is in fact very reassuring in showing no apparent link between pregnancy ultrasound and risk of autism. It's a shame that the paper as it is presented is open to some misinterpretation which we feel sure neither the authors nor journal would have wanted to see.”

Perinatal Doppler and Vascular Focus Group (Chair), UOG Editorial Board

Christoph Lees is Professor of Obstetrics as Imperial College London; Honorary Consultant in Obstetrics and Head of Specialty for Fetal Medicine at the Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare NHS Trust; Clinical Director for Fetal Medicine for North West London and Visiting Professor KU Leuven (Belgium).  His research interest is on fetal assessment and in particular the use of Doppler ultrasound to assess the health of the baby, scanning in labour, and non-invasive fetal surgery. He is the Chief Investigator of The Trial of Umbilical and Fetal Flow in Europe (TRUFFLE), a Collaboration of 51 Centres across Europe; co-founder of the International Working Group of Maternal Haemodynamics and Intrapartum ultrasound ISLANDs group. He was awarded £2.2m grant from the Medical Research Council for first in human studies of high-intensity focused ultrasound in 2017, a £2.5m grant from the NIHR in 2019 to undertake the TRUFFLE 2 RCT and a £2.1M grant from the NIHR for a study on ultrasound of breech pregnancy at 36 weeks in 2023. 
 
Country: UK

Field: Obstetrics

Specialties: Fetal anomaly screening T2; fetal biometry and wellbeing; aneuploidies; fetal anomalies; fetal growth restriction; maternal and fetal Doppler; preeclampsia; safety of ultrasound

Language: English
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