Gestational Exposure to Selective Serotonin Reuptake Inhibitors and Offspring Psychiatric Disorders: A National Register-Based Study.
Gestational Exposure to Selective Serotonin Reuptake Inhibitors and Offspring Psychiatric Disorders: A National Register-Based Study.
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DOI：
10.1016/j.jaac.2016.02.013
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发表时间：
2016-05
影响因子：
13.3
通讯作者：
Sourander A
中科院分区：
文献类型：
--
作者：
Malm H;Brown AS;Gissler M;Gyllenberg D;Hinkka-Yli-Salomäki S;McKeague IW;Weissman M;Wickramaratne P;Artama M;Gingrich JA;Sourander A
目的探讨孕期暴露于选择性5-羟色胺再摄取抑制剂(SSRIs)对子代神经发育的影响。这是一项队列研究，使用了芬兰1996-2010年间的国家登记数据。孕妇及其子女被分成四组：暴露于SSRI(n=15,729)；暴露于精神障碍，未服用抗抑郁药(n=9,651)；仅在孕前暴露于SSRI(n=7,980)；以及未暴露于抗抑郁药和精神障碍(n=31,394)。我们调查了四个组从出生到14岁的子女被诊断为抑郁、焦虑、自闭症谱系障碍(ASDS)和注意力缺陷/多动障碍(ADHD)的累积发生率，调整了混杂因素。在产前暴露于SSRIs的子女中，到14.9岁时，抑郁的累积发生率为8.2%(95%CI，3.1-13.3%)，而在精神障碍、未服药组(调整后的风险比[HR]，1.78；95%CI，1.12-2.82；p=0.02)中为1.9%(95%CI，0.9-2.9%)，在SSRI停用组(HR 1.84；95%可信区间为1.14-2.97；p=.01)。焦虑、自闭症和ADHD的诊断率与患有精神障碍但怀孕期间没有药物治疗的母亲的子女的比率相当。与暴露于未暴露的SSRI相比，每种结果的HRs均显著升高。产前接触SSRI与青春期早期抑郁症诊断率的增加有关，但与ASD或ADHD无关。在得到证实之前，必须权衡这些发现与未经治疗的产妇抑郁症的严重不良后果。
To investigate the impact of gestational exposure to selective serotonin reuptake inhibitors (SSRIs) on offspring neurodevelopment. This is a cohort study using national register data in Finland between the years 1996-2010. Pregnant women and their offspring were categorized into four groups: SSRI exposed (n=15,729); exposed to psychiatric disorder, no antidepressants (n=9,651); exposed to SSRIs only before pregnancy (n=7,980); and unexposed to antidepressants and psychiatric disorders (n=31,394). We investigated the cumulative incidence of offspring diagnoses of depression, anxiety, autism spectrum disorders (ASDs), and attention-deficit/hyperactivity disorders (ADHD) for the four groups from birth to 14 years, adjusting for confounders. The cumulative incidence of depression among offspring exposed prenatally to SSRIs was 8.2% (95% CI, 3.1-13.3%) by age 14.9, compared to 1.9% (95% CI, 0.9-2.9%) in the psychiatric disorder, no medication group (adjusted hazard ratio [HR], 1.78; 95% CI, 1.12-2.82; p=.02) and to 2.8% (95% CI, 1.4-4.3%) in the SSRI discontinued group (HR 1.84; 95% CI, 1.14-2.97; p=.01). Rates of anxiety, ASD, and ADHD diagnoses were comparable to rates in offspring of mothers with a psychiatric disorder but no medication during pregnancy. Comparing SSRI exposed to unexposed, the HRs were significantly elevated for each outcome. Prenatal SSRI exposure was associated with increased rates of depression diagnoses in early adolescence but not with ASD or ADHD. Until confirmed, these findings must be balanced against the substantial adverse consequences of untreated maternal depression.