孕期接触对乙酰氨基酚与注意缺陷多动障碍风险
Prenatal Exposure to Acetaminophen and Risk of ADHD.
作者信息
Ystrom Eivind, Gustavson Kristin, Brandlistuen Ragnhild Eek, Knudsen Gun Peggy, Magnus Per, Susser Ezra, Davey Smith George, Stoltenberg Camilla, Surén Pål, Håberg Siri E, Hornig Mady, Lipkin W Ian, Nordeng Hedvig, Reichborn-Kjennerud Ted
机构信息
Norwegian Institute of Public Health, Oslo, Norway;
Section of Health, Developmental, and Personality Psychology, Department of Psychology.
出版信息
Pediatrics. 2017 Nov;140(5). doi: 10.1542/peds.2016-3840.
OBJECTIVES
To estimate the association between maternal use of acetaminophen during pregnancy and of paternal use before pregnancy with attention-deficit/hyperactivity disorder (ADHD) in offspring while adjusting for familial risk for ADHD and indications of acetaminophen use.
METHODS
Diagnoses were obtained from the Norwegian Patient Registry for 112 973 offspring from the Norwegian Mother and Child Cohort Study, including 2246 with ADHD. We estimated hazard ratios (HRs) for an ADHD diagnosis by using Cox proportional hazard models.
RESULTS
After adjusting for maternal use of acetaminophen before pregnancy, familial risk for ADHD, and indications of acetaminophen use, we observed a modest association between any prenatal maternal use of acetaminophen in 1 (HR = 1.07; 95% confidence interval [CI] 0.96-1.19), 2 (HR = 1.22; 95% CI 1.07-1.38), and 3 trimesters (HR = 1.27; 95% CI 0.99-1.63). The HR for more than 29 days of maternal acetaminophen use was 2.20 (95% CI 1.50-3.24). Use for <8 days was negatively associated with ADHD (HR = 0.90; 95% CI 0.81-1.00). Acetaminophen use for fever and infections for 22 to 28 days was associated with ADHD (HR = 6.15; 95% CI 1.71-22.05). Paternal and maternal use of acetaminophen were similarly associated with ADHD.
CONCLUSIONS
Short-term maternal use of acetaminophen during pregnancy was negatively associated with ADHD in offspring. Long-term maternal use of acetaminophen during pregnancy was substantially associated with ADHD even after adjusting for indications of use, familial risk of ADHD, and other potential confounders.
目的
评估孕期母亲使用对乙酰氨基酚以及孕前父亲使用对乙酰氨基酚与后代注意力缺陷多动障碍（ADHD）之间的关联，同时对ADHD的家族风险和对乙酰氨基酚使用指征进行校正。
方法
从挪威母婴队列研究的112973名后代的挪威患者登记处获取诊断信息，其中包括2246名患有ADHD的患者。我们使用Cox比例风险模型估计ADHD诊断的风险比（HRs）。
结果
在校正孕前母亲使用对乙酰氨基酚、ADHD的家族风险以及对乙酰氨基酚使用指征后，我们观察到孕期母亲在第1（HR = 1.07；95%置信区间[CI] 0.96 - 1.19）、第2（HR = 1.22；95% CI 1.07 - 1.38）和第3孕期（HR = 1.27；95% CI 0.99 - 1.63）任何时间使用对乙酰氨基酚与ADHD之间存在适度关联。母亲使用对乙酰氨基酚超过29天的HR为2.20（95% CI 1.50 - 3.24）。使用时间<8天与ADHD呈负相关（HR = 0.90；95% CI 0.81 - 1.00）。因发烧和感染使用对乙酰氨基酚22至28天与ADHD相关（HR = 6.15；95% CI 1.71 - 22.05）。父亲和母亲使用对乙酰氨基酚与ADHD的关联相似。
结论
孕期母亲短期使用对乙酰氨基酚与后代ADHD呈负相关。即使在校正使用指征、ADHD的家族风险和其他潜在混杂因素后，孕期母亲长期使用对乙酰氨基酚仍与ADHD密切相关。
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