Autism risk following antidepressant medication during pregnancy.
Autism risk following antidepressant medication during pregnancy.
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DOI：
10.1017/s0033291717001301
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发表时间：
2017-12
影响因子：
6.9
通讯作者：
Sandin S
中科院分区：
文献类型：
--
作者：
Viktorin A;Uher R;Reichenberg A;Levine SZ;Sandin S
此前的研究已经检验了母亲在怀孕期间服用抗抑郁药物是否会增加后代患自闭症谱系障碍（ASD）的风险，但结果相互矛盾。在一个由 2006 年和 2007 年出生、2014 年 7 岁和 8 岁儿童组成的 179 007 名儿童的人口队列中，我们估计了妊娠期间接触任何抗抑郁药物和九种特定抗抑郁药物的儿童的 ASD 相对风险 (RR) 和 Cox 回归的 95% 置信区间 (CI)。分析针对潜在的混杂因素进行了调整，并在整个人群样本以及一生中至少有一次被诊断为抑郁或焦虑的母亲的临床相关子样本中进行。妊娠期间使用抗抑郁药物的母亲所生孩子的 ASD 调整后 RR 估计为 1.23 (95% CI 0.96–1.57)，而有抑郁或焦虑病史的女性则为 1.07 (95% CI 0.80–1.43)。对特定抗抑郁药物的分析最初显示，后代 ASD 的 RR 增加仅限于西酞普兰和艾司西酞普兰（RR：1.47；95% CI 0.92-2.35）和氯米帕明（RR：2.86；95% CI 1.04-7.82）。怀孕期间服用抗抑郁药似乎与后代患自闭症谱系障碍的风险增加没有因果关系。相反，结果表明这种关联是通过与精神疾病的潜在易感性相关的因素来解释的。基于这些发现，后代患 ASD 的风险不应成为停止孕妇使用常用抗抑郁药物治疗的考虑因素。
Previous studies have examined if maternal antidepressant medication during pregnancy increase the risk of autism spectrum disorder (ASD) in the offspring, but the results have been conflicting. In a population-based cohort of 179 007 children born in 2006 and 2007 and followed through 2014 when aged 7 and 8, we estimated relative risks (RRs) of ASD and 95% confidence intervals (CIs) from Cox regression in children exposed to any antidepressant medication during pregnancy, and nine specific antidepressant drugs. Analyses were adjusted for potential confounders and were conducted in the full population sample, and in a clinically relevant sub-sample of mothers with at least one diagnosis of depression or anxiety during life. The adjusted RR of ASD in children of mothers who used antidepressant medication during pregnancy was estimated at 1.23 (95% CI 0.96–1.57), and at 1.07 (95% CI 0.80–1.43) in women with a history of depression or anxiety. Analyses of specific antidepressants initially revealed increased RRs of offspring ASD confined to citalopram and escitalopram (RR: 1.47; 95% CI 0.92–2.35) and clomipramine (RR: 2.86; 95% CI 1.04–7.82). Medication with antidepressants during pregnancy does not appear to be causally associated with an increased risk of ASD in the offspring. Instead, the results suggest that the association is explained by factors related to the underlying susceptibility to psychiatric disorders. Based on these findings, the risk of ASD in the offspring should not be a consideration to withhold treatment with commonly used antidepressant drugs from pregnant women.