Regional Centre of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark.
Clin Epidemiol. 2013 Nov 15;5:449-59. doi: 10.2147/CLEP.S53009. eCollection 2013.
Both the use of antidepressant medication during pregnancy and the prevalence of autism spectrum disorder have increased during recent years. A causal link has recently been suggested, but the association may be confounded by the underlying indication for antidepressant use. We investigated the association between maternal use of antidepressant medication in pregnancy and autism, controlling for potential confounding factors.
We identified all children born alive in Denmark 1996-2006 (n=668,468) and their parents in the Danish Civil Registration System. We obtained information on the mother's prescriptions filled during pregnancy from the Danish National Prescription Registry, and on diagnoses of autism spectrum disorders in the children and diagnoses of psychiatric disorders in the parents from the Danish Psychiatric Central Register. In a cohort analysis, we estimated hazard ratios of autism spectrum disorders in children exposed to antidepressant medication during pregnancy compared with children who were not exposed, using Cox proportional hazards regression analysis. Furthermore, we estimated the risk for autism spectrum disorder in a sibling design.
Children exposed prenatally to antidepressants had an adjusted hazard ratio of 1.5 (95% confidence interval [CI] 1.2-1.9) for autism spectrum disorder compared with unexposed children. Restricting the analysis to children of women with a diagnosis of affective disorder, the adjusted hazard ratio was 1.2 (95% CI 0.7-2.1), and the risk was further reduced when exposed children were compared with their unexposed siblings (adjusted hazard ratio 1.1; 95% CI 0.5-2.3).
After controlling for important confounding factors, there was no significant association between prenatal exposure to antidepressant medication and autism spectrum disorders in the offspring.
近年来，怀孕期间使用抗抑郁药物和自闭症谱系障碍的患病率都有所增加。最近有人提出了一种因果关系，但这种关联可能因抗抑郁药物使用的潜在指征而受到混淆。我们调查了怀孕期间母亲使用抗抑郁药物与自闭症之间的关联，同时控制了潜在的混杂因素。
我们在丹麦民事登记系统中确定了 1996 年至 2006 年期间出生的所有活产儿（n=668468）及其父母。我们从丹麦国家处方登记处获得了母亲怀孕期间的处方信息，从丹麦精神病中央登记处获得了儿童自闭症谱系障碍的诊断和父母的精神疾病诊断信息。在队列分析中，我们使用 Cox 比例风险回归分析估计了暴露于怀孕期间抗抑郁药物的儿童与未暴露于儿童的自闭症谱系障碍的风险比（hazard ratio）。此外，我们还在同胞设计中估计了自闭症谱系障碍的风险。
与未暴露于儿童相比，产前暴露于抗抑郁药物的儿童自闭症谱系障碍的调整风险比为 1.5（95%置信区间[CI] 1.2-1.9）。将分析限制在患有情感障碍诊断的女性的孩子中，调整后的风险比为 1.2（95% CI 0.7-2.1），当将暴露儿童与未暴露的兄弟姐妹进行比较时，风险进一步降低（调整后的风险比为 1.1；95% CI 0.5-2.3）。
在控制了重要的混杂因素后，产前暴露于抗抑郁药物与后代的自闭症谱系障碍之间没有显著关联。
