Johnson Katrina C, LaPrairie Jamie L, Brennan Patricia A, Stowe Zachary N, Newport D Jeffrey
Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia, USA.
Arch Gen Psychiatry. 2012 Aug;69(8):787-94. doi: 10.1001/archgenpsychiatry.2012.160.
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.
DESIGN, SETTING, AND PARTICIPANTS: 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 (F(2,281)=4.51; P=.01; partial η(2)=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 (r(245)=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.
尽管抗精神病药物在精神障碍之外的临床应用不断扩大，已涵盖抑郁、双相和焦虑障碍，但关于胎儿接触抗精神病药物的神经发育后遗症的生殖安全性数据却很匮乏。
研究子宫内接触抗精神病药物是否与6个月大婴儿的神经运动表现和习惯化缺陷有关。
设计、地点和参与者：1999年12月至2008年6月在埃默里心理中心的婴儿发育实验室进行了一项前瞻性对照研究，对产后6个月的母婴二元组（N = 309）进行研究，这些母婴在孕期接触过抗精神病药物（n = 22）、抗抑郁药物（n = 202）或未接触过精神药物（n = 85）。对母婴接触情况不知情的检查人员进行了标准化的神经运动检查（国际婴儿神经学检查表[INFANIB]），该检查测试姿势、肌张力、反射和运动技能，并使用中性女性面孔进行视觉习惯化范式测试。
INFANIB综合评分；在视觉习惯化任务中婴儿注视次数减少50%所需的试验次数；以及10次试验中注视刺激的平均时间。
在控制了显著的协变量后（F(2,281)=4.51；P = 0.01；偏η(2)=0.033），产前接触抗精神病药物的婴儿（平均 = 64.71）的INFANIB评分显著低于接触抗抑郁药物的婴儿（平均 = 68.57）或未接触精神药物的婴儿（平均 = 71.19）。INFANIB评分也与母亲的精神病史显著相关，包括抑郁症、精神病以及总体严重程度/慢性病程（P <.05），孕期母亲抑郁与习惯化效率较低有关（r(245)=0.16；P <.02）。药物接触组之间在习惯化方面没有显著差异。
在6个月大的婴儿中，与接触抗抑郁药物或未接触精神药物相比，子宫内接触抗精神病药物的病史与神经运动表现的标准测试得分显著较低有关，这突出表明需要进一步审查胎儿接触抗精神病药物的生殖安全性和神经发育后遗症。区分药物影响和同样起作用的母亲疾病影响仍然是一项关键挑战。
