Viktorin Alexander, Uher Rudolf, Kolevzon Alexander, Reichenberg Abraham, Levine Stephen Z, Sandin Sven
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
The Seaver Autism Center for Research and Treatment, Mount Sinai, New York, New York.
JAMA Psychiatry. 2017 Oct 1;74(10):1031-1038. doi: 10.1001/jamapsychiatry.2017.1727.
Maternal antidepressant medication use during pregnancy has previously been associated with adverse outcomes in offspring, but to our knowledge, the association with intellectual disability (ID) has not been investigated.
To examine the association of maternal antidepressant medication use during pregnancy with ID in offspring and investigate the importance of parental mental illness for such an association.
DESIGN, SETTING, AND PARTICIPANTS: A population-based cohort study of 179 007 children born from January 1, 2006, through December 31, 2007, with complete parental information from national registers who were followed up from birth throughout 2014.
We estimated relative risks (RRs) and 95% CIs of ID in children exposed during pregnancy to any antidepressant medication or specifically to selective serotonin reuptake inhibitor (SSRI) antidepressants, all other non-SSRI antidepressants, or other nonantidepressant psychotropic medications. Analyses were adjusted for potential confounders. In addition to full population analyses, we used a subsample to compare mothers who used antidepressants during pregnancy with mothers who had at least one diagnosis of depression or anxiety before childbirth but did not use antidepressants during pregnancy.
Of the 179 007 children included in the study (mean [SD] age at end of follow-up, 7.9 [0.6] years; 92 133 [51.5%] male and 86 874 [48.5%] female), ID was diagnosed in 37 children (0.9%) exposed to antidepressants and in 819 children (0.5%) unexposed to antidepressants. With adjustment for potential confounders, the RR of ID after antidepressant exposure was estimated at 1.33 (95% CI, 0.90-1.98) in the full population sample and 1.64 (95% CI, 0.95-2.83) in the subsample of women with depression. Results from analyses of SSRI antidepressants, non-SSRI antidepressants, and nonantidepressant psychotropic medications and analyses in the clinically relevant subsample did not deviate from the full-sample results.
The unadjusted RR of ID was increased in offspring born to mothers treated with antidepressants during pregnancy. After adjustment for confounding factors, however, the current study did not find evidence of an association between ID and maternal antidepressant medication use during pregnancy. Instead, the association may be attributable to a mechanism integral to other factors, such as parental age and mother's psychiatric disorder.
此前已发现孕期母亲使用抗抑郁药物与后代不良结局有关，但据我们所知，与智力残疾（ID）的关联尚未得到研究。
研究孕期母亲使用抗抑郁药物与后代智力残疾之间的关联，并调查父母精神疾病对这种关联的重要性。
设计、地点和参与者：一项基于人群的队列研究，研究对象为179007名于2006年1月1日至2007年12月31日出生的儿童，其父母信息完整，来自国家登记处，从出生一直随访至2014年。
我们估计了孕期暴露于任何抗抑郁药物、或具体暴露于选择性5-羟色胺再摄取抑制剂（SSRI）类抗抑郁药、所有其他非SSRI类抗抑郁药或其他非抗抑郁精神药物的儿童患智力残疾的相对风险（RRs）及95%置信区间（CIs）。分析对潜在混杂因素进行了校正。除了全人群分析外，我们还使用了一个子样本，比较孕期使用抗抑郁药物的母亲与分娩前至少有一次抑郁或焦虑诊断但孕期未使用抗抑郁药物的母亲。
在纳入研究的179007名儿童中（随访结束时的平均[标准差]年龄为7.9[0.6]岁；男性92133名[51.5%]，女性86874名[48.5%]），37名（0.9%）暴露于抗抑郁药物的儿童和819名（0.5%）未暴露于抗抑郁药物的儿童被诊断为智力残疾。校正潜在混杂因素后，全人群样本中抗抑郁药物暴露后患智力残疾的RR估计为1.33（95%CI，0.90 - 1.98），抑郁症女性子样本中的RR为1.64（95%CI，0.95 - 2.83）。SSRI类抗抑郁药、非SSRI类抗抑郁药和非抗抑郁精神药物的分析结果以及临床相关子样本中的分析结果与全样本结果无偏差。
孕期接受抗抑郁药物治疗的母亲所生后代未校正的智力残疾RR有所增加。然而，在校正混杂因素后，本研究未发现智力残疾与孕期母亲使用抗抑郁药物之间存在关联的证据。相反，这种关联可能归因于其他因素（如父母年龄和母亲的精神疾病）所共有的一种机制。
