Gentile Salvatore
Department of Mental Health ASL Salerno Mental Health Center, n. 63, Piazza Galdi, 841013 Cava de׳ Tirreni, Salerno, Italy; University of Naples, Medical School "Federico II", Department of Neurosciences - Perinatal Psychiatry, Via S. Pansini, 5, 80131 Naples, Italy.
J Affect Disord. 2015 Aug 15;182:132-7. doi: 10.1016/j.jad.2015.04.048. Epub 2015 May 6.
Recent information suggests that antenatal exposure to psychotropics may impair child neurodevelopment. Thus, aim of this review is to examine systematically available literature investigating potential associations between prenatal use of selective serotonin reuptake inhibitors (SSRIs) and the risk of autism spectrum disorders (ASDs).
Medical literature published in English since 1988 identified using MEDLINE/PubMed, EMBASE, SCOPUS, and The Cochrane Library. Search terms: antidepressants, autism (spectrum disorders), childhood, children, neurodevelopment, pregnancy, SSRIs. Searches were updated until March 5, 2015.
Six out of eight reviewed articles confirm an association between antenatal SSRI exposure and an increased risk of ASDs in children. However, the epidemiologic evidence on the link between prenatal SSRI exposure and ASD risk must still be cautiously interpreted, because of potential biases of analyzed research.
Main limitations of reviewed studies include: lack of directly validated clinical evaluation, impossibility to identify women who really took the prescribed medications during pregnancy, no assessment of severity and course of symptoms in relation to the pregnancy, lack of information about unhealthy prenatal lifestyle behaviors.
Despite such limitations, available data show that some signal exists suggesting that antenatal exposure to SSRIs may increase the risk of ASDs. Thus, there is an urgent need for further, large, well-designed research finalized to definitively assess the existence and the magnitude of this severe risk, thus confirming or denying that we are truly looking at "the fall of Gods", since for many years SSRIs have been considered the first-choice agents for treating antenatal depression (Gentile, 2014; Gentile, 2011a; Gentile, 2005).
近期信息表明，产前接触精神药物可能会损害儿童神经发育。因此，本综述的目的是系统审查现有文献，研究产前使用选择性5-羟色胺再摄取抑制剂（SSRI）与自闭症谱系障碍（ASD）风险之间的潜在关联。
使用MEDLINE/PubMed、EMBASE、SCOPUS和考克兰图书馆检索自1988年以来以英文发表的医学文献。检索词：抗抑郁药、自闭症（谱系障碍）、儿童期、儿童、神经发育、妊娠、SSRI。检索持续更新至2015年3月5日。
八篇综述文章中有六篇证实产前暴露于SSRI与儿童ASD风险增加之间存在关联。然而，由于分析研究存在潜在偏倚，关于产前暴露于SSRI与ASD风险之间联系的流行病学证据仍需谨慎解读。
综述研究的主要局限性包括：缺乏直接有效的临床评估、无法识别孕期真正服用规定药物的女性、未评估与妊娠相关的症状严重程度和病程、缺乏不健康产前生活方式行为的信息。
尽管存在这些局限性，但现有数据显示存在一些迹象，表明产前暴露于SSRI可能会增加患ASD的风险。因此，迫切需要进一步开展大规模、设计良好的研究，以最终确定这种严重风险的存在及程度，从而证实或否定我们是否真的在目睹“诸神陨落”，因为多年来SSRI一直被视为治疗产前抑郁症的首选药物（Gentile，2014；Gentile，2011a；Gentile，2005）。
