Antidepressant Use During Pregnancy and Childhood Autism Spectrum Disorders
Antidepressant Use During Pregnancy and Childhood Autism Spectrum Disorders
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DOI：
10.1001/archgenpsychiatry.2011.73
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发表时间：
2011-11-01
影响因子：
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通讯作者：
Hendrick, Victoria
中科院分区：
文献类型：
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作者：
Croen, Lisa A.;Grether, Judith K.;Hendrick, Victoria
背景：自闭症谱系障碍（ASD）的患病率近年来有所增加。在怀孕期间使用抗抑郁药物也显示了长期的增加，在最近几十年，提示关注产前暴露可能有助于增加ASD的风险。目的：系统地评估是否产前暴露于抗抑郁药物与ASD的风险增加。设计：基于人群的病例对照研究。使用医疗记录来确定病例儿童和对照儿童，并获得有关母亲使用抗抑郁药物、母亲心理健康史以及人口统计学和医学协变量的前瞻性记录信息。设置：凯撒医疗机构医疗护理计划在北方加州。参与者：298例ASD患儿（和他们的母亲）和1507名随机选择的对照儿童（和他们的母亲）来自北方加州Kaiser Permanente医疗护理计划的成员。主要结果测量：ASD。结果：20例病例儿童（6.7%）和50例对照儿童（3.3%）报告了产前暴露于抗抑郁药物。在校正的逻辑回归模型中，我们发现在分娩前一年母亲使用选择性5-羟色胺再摄取抑制剂治疗与ASD风险增加2倍（校正比值比，2.2 [95%置信区间，1.2-4.3]），与妊娠早期治疗相关的效应最强（调整后的比值比，3.8 [95%置信区间，1.8-7.8]）。没有增加的风险被发现的母亲在没有产前暴露于选择性5-羟色胺再摄取抑制剂的精神健康治疗的历史。结论：虽然产前暴露于选择性5-羟色胺再摄取抑制剂的儿童人数在这一人群是低的，结果表明，暴露，特别是在头三个月，可能会适度增加ASD的风险。与暴露相关的潜在风险必须与母亲或胎儿未经治疗的精神健康疾病的风险相平衡。需要进一步的研究来复制和扩展这些发现。
Context: The prevalence of autism spectrum disorders (ASDs) has increased over recent years. Use of antidepressant medications during pregnancy also shows a secular increase in recent decades, prompting concerns that prenatal exposure may contribute to increased risk of ASD.Objective: To systematically evaluate whether prenatal exposure to antidepressant medications is associated with increased risk of ASD.Design: Population-based case-control study. Medical records were used to ascertain case children and control children and to derive prospectively recorded information on mothers' use of antidepressant medications, mental health history of mothers, and demographic and medical covariates.Setting: The Kaiser Permanente Medical Care Program in Northern California.Participants: A total of 298 case children with ASD (and their mothers) and 1507 randomly selected control children (and their mothers) drawn from the membership of the Kaiser Permanente Medical Care Program in Northern California.Main Outcome Measures: ASDs.Results: Prenatal exposure to antidepressant medications was reported for 20 case children (6.7%) and 50 control children (3.3%). In adjusted logistic regression models, we found a 2-fold increased risk of ASD associated with treatment with selective serotonin reuptake inhibitors by the mother during the year before delivery (adjusted odds ratio, 2.2 [95% confidence interval, 1.2-4.3]), with the strongest effect associated with treatment during the first trimester (adjusted odds ratio, 3.8 [95% confidence interval, 1.8-7.8]). No increase in risk was found for mothers with a history of mental health treatment in the absence of prenatal exposure to selective serotonin reuptake inhibitors.Conclusion: Although the number of children exposed prenatally to selective serotonin reuptake inhibitors in this population was low, results suggest that exposure, especially during the first trimester, may modestly increase the risk of ASD. The potential risk associated with exposure must be balanced with the risk to the mother or fetus of untreated mental health disorders. Further studies are needed to replicate and extend these findings.