Why can signals that appear consistent across many studies still reflect shared bias; how do sibling comparisons help recalibrate cumulative evidence; and what AI-enabled approaches can add to large-scale evidence integration? Viktor H. Ahlqvist, PhD, from the Karolinska Institute joins JAMA and JAMA+ AI Associate Editor Yulin Hswen, ScD, MPH, to discuss why automated drug safety surveillance during pregnancy is urgently needed and how AI and computation can strengthen or undermine causal inference.