Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
BJOG. 2018 Aug;125(9):1077-1084. doi: 10.1111/1471-0528.15059. Epub 2018 Jan 10.
Evidence for the relationship between antidepressant use during pregnancy and the risk of attention-deficit/hyperactivity disorder (ADHD) in the children is conflicting.
To assess the association between fetal exposure to antidepressant drugs and the subsequent development of ADHD.
A systematic literature search was conducted in PubMed, EMBASE, PsycINFO, and CINAHL databases to identify relevant cohort studies published from inception until October 2017.
Cohort studies, identifying children with ADHD diagnosis and linking antidepressant use during pregnancy in their mothers.
Two reviewers independently abstracted data and assessed study quality.
The literature search identified six relevant cohort studies with association between antidepressant exposure during pregnancy and the risk of ADHD in children [hazard ratio (HR) 1.34; 95% confidence interval (CI) 1.14-1.57]. However, the association was not statistically significant when the reference group was mothers with psychiatric disorders not treated during pregnancy (HR 0.96; 95% CI 0.76-1.2; n = 2 studies). Moreover, preconception exposure to antidepressants was significantly associated with increased risk of ADHD (HR 1.82; 95% CI 1.54-2.15; n = 3 studies).
The significant association between antidepressant exposure during pregnancy and ADHD in the children can be partially explained by confounding by indication. Given the low number of included studies, further studies with prospective designs that use validated measurements and controls for important confounders are needed to verify our findings.
Antidepressant use during pregnancy may be not associated with ADHD in the offspring.
关于妊娠期使用抗抑郁药物与儿童注意缺陷多动障碍（ADHD）风险之间的关系，现有证据相互矛盾。
评估胎儿暴露于抗抑郁药物与随后发生 ADHD 之间的关联。
系统检索了 PubMed、EMBASE、PsycINFO 和 CINAHL 数据库，以确定自成立至 2017 年 10 月发表的相关队列研究。
队列研究，确定 ADHD 诊断的儿童，并将其母亲妊娠期使用抗抑郁药物情况进行关联。
两名审查员独立提取数据并评估研究质量。
文献检索确定了 6 项相关队列研究，这些研究显示妊娠期暴露于抗抑郁药物与儿童发生 ADHD 的风险之间存在关联[风险比（HR）1.34；95%置信区间（CI）1.14-1.57]。然而，当参考组为妊娠期未治疗精神疾病的母亲时，这种关联无统计学意义（HR 0.96；95%CI 0.76-1.2；n=2 项研究）。此外，妊娠前接触抗抑郁药与 ADHD 风险增加显著相关（HR 1.82；95%CI 1.54-2.15；n=3 项研究）。
妊娠期暴露于抗抑郁药物与儿童发生 ADHD 之间的显著关联部分可以用指示性混杂来解释。鉴于纳入研究的数量较少，需要进一步开展前瞻性设计的研究，使用经过验证的测量方法并控制重要混杂因素，以验证我们的研究结果。
妊娠期使用抗抑郁药物可能与后代发生 ADHD 无关。
