Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children
Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children
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DOI：
10.1001/jamapediatrics.2015.3356
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发表时间：
2016-02-01
期刊：
影响因子：
26.1
通讯作者：
Berard, Anick
中科院分区：
文献类型：
--
作者：
Boukhris, Takoua;Sheehy, Odile;Berard, Anick
妊娠期使用抗抑郁药与儿童自闭症谱系障碍（ASD）风险之间的关系仍然存在争议。ASD的病因尚不清楚，尽管研究涉及遗传易感性、环境危险因素和母亲depress. ObjectiveTo检查与妊娠期抗抑郁药使用相关的儿童ASD的风险，根据暴露的三个月并考虑母亲depress.Design，设置和参与者我们进行了一项正在进行的以人群为基础的队列研究，魁北克怀孕/儿童队列，包括1998年1月1日至2009年12月31日期间魁北克所有怀孕和儿童的数据。共纳入145456例活产的单胎足月婴儿，其母亲在怀孕前和怀孕期间至少12个月接受魁北克疾病保险计划的保险。数据分析从2014年10月1日至2015年6月30日进行。暴露根据妊娠期和特定的抗抑郁药类别定义妊娠期间的抗抑郁药暴露。主要结局和指标ASD儿童定义为在出生日期和最后随访日期之间至少有1次ASD诊断的儿童。考克斯比例风险回归模型被用来估计粗和调整后的风险比与95%CIs.Results在904 035.50人年的后续行动，1054名儿童（0.7%）被诊断为ASD，ASD的男孩超过女孩的比例约为4：1。随访结束时儿童的平均（SD）年龄为6.24（3.19）岁。调整潜在混杂因素后，妊娠中期和/或晚期使用抗抑郁药与ASD风险相关（31例暴露婴儿;调整后风险比，1.87; 95%CI，1.15-3.04）。在妊娠中期和/或晚期使用选择性5-羟色胺再摄取抑制剂与ASD风险增加显著相关（22例暴露婴儿;校正风险比，2.17; 95%CI，1.20-3.93）。即使考虑到母亲的抑郁症史（29暴露的婴儿，调整后的危害比，1.75; 95%CI，1.03-2.97）的风险是持久的。结论和相关性使用抗抑郁药，特别是选择性5-羟色胺再摄取抑制剂，在第二和/或第三个三个月的儿童ASD的风险增加，即使考虑到母亲的抑郁症。需要进一步的研究来具体评估妊娠期间与抗抑郁药类型和剂量相关的ASD风险。
IMPORTANCE The association between the use of antidepressants during gestation and the risk of autism spectrum disorder (ASD) in children is still controversial. The etiology of ASD remains unclear, although studies have implicated genetic predispositions, environmental risk factors, and maternal depression.OBJECTIVE To examine the risk of ASD in children associated with antidepressant use during pregnancy according to trimester of exposure and taking into account maternal depression.DESIGN, SETTING, AND PARTICIPANTS We conducted a register-based study of an ongoing population-based cohort, the Quebec Pregnancy/Children Cohort, which includes data on all pregnancies and children in Quebec from January 1, 1998, to December 31, 2009. A total of 145 456 singleton full-term infants born alive and whose mothers were covered by the Regie de l'assurance maladie du Quebec drug plan for at least 12 months before and during pregnancy were included. Data analysis was conducted from October 1, 2014, to June 30, 2015.EXPOSURES Antidepressant exposure during pregnancy was defined according to trimester and specific antidepressant classes.MAIN OUTCOMES AND MEASURES Children with ASD were defined as those with at least 1 diagnosis of ASD between date of birth and last date of follow-up. Cox proportional hazards regression models were used to estimate crude and adjusted hazard ratios with 95% CIs.RESULTS During 904 035.50 person-years of follow-up, 1054 children (0.7%) were diagnosed with ASD; boys with ASD outnumbered girls by a ratio of about 4:1. The mean (SD) age of children at the end of follow-up was 6.24 (3.19) years. Adjusting for potential confounders, use of antidepressants during the second and/or third trimester was associated with the risk of ASD (31 exposed infants; adjusted hazard ratio, 1.87; 95% CI, 1.15-3.04). Use of selective serotonin reuptake inhibitors during the second and/or third trimester was significantly associated with an increased risk of ASD (22 exposed infants; adjusted hazard ratio, 2.17; 95% CI, 1.20-3.93). The risk was persistent even after taking into account maternal history of depression (29 exposed infants; adjusted hazard ratio, 1.75; 95% CI, 1.03-2.97).CONCLUSIONS AND RELEVANCE Use of antidepressants, specifically selective serotonin reuptake inhibitors, during the second and/or third trimester increases the risk of ASD in children, even after considering maternal depression. Further research is needed to specifically assess the risk of ASD associated with antidepressant types and dosages during pregnancy.