Andrade Chittaranjan
Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India.
J Clin Psychiatry. 2017 Sep/Oct;78(8):e1047-e1051. doi: 10.4088/JCP.17f11903.
There are no randomized controlled trials of antidepressant drugs to treat depression, or to prevent relapse into depression, during pregnancy; therefore, the safety of antidepressant drug exposure during pregnancy is based on evidence from case-control or cohort studies. Many of these observational studies, during the past decade, examined the risk of autism spectrum disorder (ASD) in exposed offspring. Different studies using different methods and examining different periods of antidepressant exposure before and during pregnancy obtained different results. Studies with adverse outcomes were highlighted in the mass media, whereas those with reassuring outcomes were mostly ignored. Meta-analyses were conducted to reconcile the findings of the different studies and determine the magnitude of the effect size. In the last year or so, at least 6 such meta-analyses examined the effects of antidepressant exposure during pregnancy on the risk of ASD in the offspring. The meta-analyses set different study selection criteria and employed different methods of analysis to address different objectives. The findings across meta-analyses have been reasonably consistent. Antidepressant exposure during pregnancy is associated with an increased risk of ASD in the offspring. The risk is decreased after adjusting for confounding variables and is mostly no longer statistically significant after adjusting for maternal mental illness. Additionally, antidepressant exposure is associated with an increased risk of ASD in the offspring even when exposure is limited to the preconception period, when the drugs cannot have a physiological effect on the fetus. These findings suggest that maternal mental illness is an important determinant of the risk of ASD associated with antidepressant exposure during pregnancy.
目前尚无关于抗抑郁药物在孕期治疗抑郁症或预防抑郁症复发的随机对照试验；因此，孕期暴露于抗抑郁药物的安全性是基于病例对照研究或队列研究的证据。在过去十年中，许多这类观察性研究考察了暴露于抗抑郁药物的后代患自闭症谱系障碍（ASD）的风险。不同的研究采用不同的方法，考察孕期前和孕期不同阶段的抗抑郁药物暴露情况，得出了不同的结果。有不良结果的研究在大众媒体上受到关注，而那些结果令人安心的研究大多被忽视。进行了荟萃分析以协调不同研究的结果并确定效应量的大小。在过去一年左右的时间里，至少有6项这样的荟萃分析考察了孕期暴露于抗抑郁药物对后代患ASD风险的影响。这些荟萃分析设定了不同的研究选择标准，并采用不同的分析方法来实现不同的目标。各荟萃分析的结果相当一致。孕期暴露于抗抑郁药物与后代患ASD的风险增加有关。在对混杂变量进行调整后，该风险降低，在对母亲精神疾病进行调整后，大多不再具有统计学意义。此外，即使暴露仅限于孕前阶段（此时药物对胎儿不可能产生生理影响），抗抑郁药物暴露也与后代患ASD的风险增加有关。这些发现表明，母亲精神疾病是孕期抗抑郁药物暴露相关ASD风险的一个重要决定因素。
