Prenatal antipsychotic exposure and neuromotor performance during infancy.
Prenatal antipsychotic exposure and neuromotor performance during infancy.
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DOI：
10.1001/archgenpsychiatry.2012.160
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发表时间：
2012-08
影响因子：
--
通讯作者：
Newport DJ
中科院分区：
文献类型：
--
作者：
Johnson KC;LaPrairie JL;Brennan PA;Stowe ZN;Newport DJ
尽管抗精神病药物的临床用途不断扩大，超出了精神病范围，包括抑郁症、双相情感障碍和焦虑症，但有关胎儿抗精神病药物暴露的神经发育后遗症的生殖安全数据却很少。旨在检查宫内抗精神病药物暴露是否与 6 个月大婴儿的神经运动表现和习惯缺陷相关。 1999 年 12 月至 2008 年 6 月，埃默里心理中心婴儿发育实验室进行了一项前瞻性对照研究，检查产后 6 个月时服用抗精神病药物 (n = 22)、抗抑郁药物 (n = 202) 或未服用精神药物 (n = 85) 的母婴二人组 (N = 309)。不了解母婴暴露状况的检查人员进行了标准化神经运动检查（婴儿神经学国际电池[INFANIB]），使用中性女性面孔测试姿势、语气、反射和运动技能以及视觉习惯范式。 INFANIB综合评分；在视觉习惯任务期间实现婴儿注视减少 50% 所需的试验数量；平均时间是观察 10 次试验中的刺激。在控制显着协变量后（F2,281=4.51；P =.01；部分 η2=0.033），产前暴露于抗精神病药物（平均值 = 64.71）的婴儿的 INFANIB 评分显着低于使用抗抑郁药物（平均值 = 68.57）或未接触精神药物（平均值 = 71.19）的婴儿。 INFANIB 评分还与母亲的精神病史显着相关，包括抑郁症、精神病和总体严重程度/慢性性 (P's<.05)，并且怀孕期间母亲的抑郁症与较低的习惯效率相关 (r245=0.16；P<.02)。药物暴露组之间的习惯没有显着差异。在 6 个月大的婴儿中，与抗抑郁药物或未接触精神药物相比，宫内抗精神病药物暴露史与神经运动表现标准测试得分显着较低相关，这凸显了需要进一步审查胎儿抗精神病药物暴露的生殖安全和神经发育后遗症。将药物效应与孕产妇疾病影响区分开来仍然是一个严峻的挑战。
Despite the expanding clinical utility of antipsychotics beyond psychotic disorders to include depressive, bipolar, and anxiety disorders, reproductive safety data regarding the neurodevelopmental sequelae of fetal antipsychotic exposure are scarce. To examine whether intrauterine antipsychotic exposure is associated with deficits in neuromotor performance and habituation in 6-month-old infants. A prospective controlled study was conducted from December 1999 through June 2008 at the Infant Development Laboratory of the Emory Psychological Center examining maternal-infant dyads (N=309) at 6 months postpartum with pregnancy exposure to antipsychotics (n=22), antidepressants (n = 202), or no psychotropic agents (n = 85). Examiners masked to maternal-infant exposure status administered a standardized neuromotor examination (Infant Neurological International Battery [INFANIB]) that tests posture, tone, reflexes, and motor skills and a visual habituation paradigm using a neutral female face. The INFANIB composite score; number of trials required to achieve a 50% decrease in infant fixation during a visual habituation task; and mean time looking at the stimulus across 10 trials. Infants prenatally exposed to antipsychotics (mean=64.71) showed significantly lower INFANIB scores than those with antidepressant (mean=68.57) or no psychotropic (mean=71.19) exposure, after controlling for significant covariates (F2,281=4.51; P =.01; partial η2=0.033). The INFANIB scores were also significantly associated with maternal psychiatric history, including depression, psychosis, and overall severity/chronicity (P’s<.05) and maternal depression during pregnancy was associated with less efficient habituation (r245=0.16; P <.02). There were no significant differences regarding habituation between medication exposure groups. Among 6-month-old infants, a history of intrauterine antipsychotic exposure, compared with antidepressant or no psychotropic exposure, was associated with significantly lower scores on a standard test of neuromotor performance, highlighting the need for further scrutiny of the reproductive safety and neurodevelopmental sequelae of fetal antipsychotic exposure. Disentangling medication effects from maternal illness effects, which also contributed, remains a critical challenge.