Primary Submission Category: Mediation
A separable effects approach to identifying the impact of prenatal anesthesia exposure on childhood behavior disorders
Authors: Caleb Miles, Amy Pitts, Ling Guo, Caleb Ing,
Presenting Author: Amy Pitts*
The U.S. Food and Drug Administration has cautioned that prenatal exposure to anesthetic drugs during the third trimester may have neurotoxic effects; however, there is limited clinical evidence available to substantiate this recommendation. To explore this claim, we analyze data from the nationwide Medicaid Analytic eXtract (MAX) from 1999 through 2013, which linked 16,778,281 deliveries to mothers enrolled in Medicaid during pregnancy. The goal of our analysis is to estimate the causal effect of exposure to anesthesia in utero on the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in the child. Isolating the effect of anesthesia from the effect of the surgical procedure is challenging due to these exposures being deterministically linked, thereby inducing an extreme positivity violation. To overcome this, we adopt the separable effects framework of Robins and Richardson (2010) to isolate the effect of anesthesia by blocking effects through variables that are assumed to completely mediate the causal pathway from surgery to DIBD. Furthermore, we develop sensitivity analyses to assess the impact of violations to our key identifying assumptions.