An alternative explanation is confounding by indication the

If you don know your heart rate, you taking power data out of context. One day, for example, you might ride a set of 15 minute intervals at 250 watts with an average HR of 165 beats per minute (bpm), and a perceived exertion (PE) of 7 on a scale of 1 to 10. The next day, you might complete the same intervals at 250 watts, but at an average HR of 160 bpm.

However, assuming causality, antidepressant use during pregnancy is unlikely to have contributed significantly towards the dramatic increase in observed prevalence of autism spectrum disorders as it explained less than 1% of cases.IntroductionThe estimated prevalence of autism spectrum disorders in the United States has dramatically increased from fewer than 5 in 10000 children in the 1980s to 1 in 88 in 2008.1 Similar increases have been reported in much of the Western world.2 Better recognition and more inclusive diagnostic criteria for autism spectrum disorders may explain this rising prevalence, but a real increase in incidence has not been ruled out.1 Relatively little is known about the causes of autism spectrum disorders and both genetic and environmental factors are implicated.3 The identification of modifiable environmental risk factors may aid in the primary prevention of some cases.A recently reported association between use of selective serotonin reuptake inhibitor (SSRI) antidepressants during pregnancy and autism spectrum disorders in offspring has raised the possibility of discovering one such modifiable causal factor.4 There is increasing interest in the role of the serotonergic system in the pathophysiology of autism, and prenatal exposure to serotonergic agents is a biologically plausible pathway.5 SSRIs have increasingly been used in the treatment of depression during pregnancy since the 1990s, mirroring the secular rise in the observed prevalence of autism spectrum disorders.4However, an association between SSRI use during pregnancy and autism may not imply a causal relation. An alternative explanation is confounding by indication the possibility that maternal depression is responsible for the associations observed between SSRIs and autism spectrum disorders in offspring.4 5 Although the relation between parental depression and risk of autism spectrum disorders is often assumed to be well established and has a genetic origin,4 6 the supporting evidence is relatively weak. Two recent meta analyses were inconclusive and reported a lack of studies with psychiatric diagnosis of parents before the birth of the child.7 8In a large population based study in Sweden, we investigated whether maternal or paternal depression identified before the birth of the child is associated with autism spectrum disorders in offspring; whether maternal antidepressant use during pregnancy is associated with autism spectrum disorder in offspring, and, if so, whether this explains any associations between maternal depression and autism; whether any associations between antidepressants and autism are unique to SSRIs or also evident for other antidepressants; and whether all the above associations are similar in offspring with autism with and without comorbid intellectual disability.MethodsWe conducted a case control study nested within the Stockholm youth cohort, which comprises all young people aged 0 to 17 years, residing in Stockholm County between 2001 and 2007 (n=589114).2 The cohort contains prospectively recorded data on the probands and their first degree relatives collected by record linkage with national and regional healthcare, social, and administrative registries using unique national identity numbers assigned to all Swedish residents.2 9 10Sweden has a well developed system of publicly funded screening, diagnostic, and follow up services relevant to autism spectrum disorders, with national and regional registers recording information about diagnosis and other details.2 Assessments for autism spectrum disorder are typically carried out by child neuropaediatric or mental health services, and, as per local guidelines, include diagnostic evaluations covering the child’s social, medical, and developmental history after interviews with the parents pandora jewelry, observation of the child, and a structured neuropsychiatric assessment including cognitive testing.2 11 We identified children with autism spectrum disorders in the Stockholm youth cohort using a multisource case ascertainment method, with registers covering all pathways of autism diagnosis and care within Stockholm County.2 Diagnoses recorded in these registers (codes from the international classification of diseases, ninth and 10th revisions, ICD 9 (299) and ICD 10 (F84), respectively, or Diagnostic and Statistical Manual of Mental Disorders, fourth edition, (299)) were supplemented by a record of care in specialist centres for autism with and without intellectual disability, where an autism diagnosis and cognitive testing is a prerequisite.

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