Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
Pediatrics. 2018 Sep;142(3). doi: 10.1542/peds.2018-0120. Epub 2018 Aug 13.
: media-1vid110.1542/5803567555001PEDS-VA_2018-0120 BACKGROUND: Increasing vaccination of pregnant women makes it important to assess safety events potentially linked to prenatal vaccination. This study investigates the association between prenatal tetanus, diphtheria, acellular pertussis (Tdap) vaccination and autism spectrum disorder (ASD) risk in offspring.
This is a retrospective cohort study of mother-child pairs with deliveries January 1, 2011 to December 31, 2014 at Kaiser Permanente Southern California hospitals. Maternal Tdap vaccination from pregnancy start to delivery date was obtained from electronic medical records. A diagnosis of ASD was obtained by using and codes. Children were managed from birth to first ASD diagnosis, end of membership, or end of follow-up (June 30, 2017). Cox proportional hazards models estimated the unadjusted and adjusted hazard ratios (HRs) for the association between maternal Tdap vaccination and ASD, with inverse probability of treatment weighting to adjust for confounding.
Women vaccinated were more likely to be Asian American or Pacific Islander, be nulliparous, have a higher education, receive influenza vaccination prenatally, and give birth at term. ASD was diagnosed in 1341 (1.6%) children, and the incidence rate was 3.78 per 1000 person years in the Tdap exposed and 4.05 per 1000 person years in the unexposed group (HR: 0.98, 95% confidence interval: 0.88-1.09). The inverse probability of treatment weighting-adjusted analyses revealed that prenatal Tdap vaccination was not associated with an increased ASD risk (HR: 0.85, 95% confidence interval: 0.77-0.95).
Prenatal Tdap vaccination was not associated with an increased ASD risk. We support recommendations to vaccinate pregnant women to protect infants, who are at highest risk of death after pertussis infection.
媒体-1vid110.1542/5803567555001PEDS-VA_2018-0120 背景：孕妇接种疫苗的比例不断增加，因此评估与产前疫苗接种相关的潜在安全事件变得非常重要。本研究调查了产前破伤风、白喉、无细胞百日咳（Tdap）疫苗接种与后代自闭症谱系障碍（ASD）风险之间的关联。
这是一项回顾性队列研究，纳入了 2011 年 1 月 1 日至 2014 年 12 月 31 日期间在凯撒永久南加州医院分娩的母婴对子。从电子病历中获取母亲从妊娠开始到分娩日期的 Tdap 疫苗接种情况。通过 和 代码获得 ASD 的诊断。从出生到首次 ASD 诊断、会员资格结束或随访结束（2017 年 6 月 30 日）对儿童进行管理。使用逆概率治疗加权法调整混杂因素后，Cox 比例风险模型估计了母亲 Tdap 疫苗接种与 ASD 之间的关联的未经调整和调整后的风险比（HR）。
接种疫苗的女性更有可能是亚裔美国人或太平洋岛民，是初产妇，受教育程度较高，产前接种流感疫苗，并足月分娩。在 1341 名（1.6%）儿童中诊断出 ASD，暴露组的发病率为每 1000 人年 3.78 例，未暴露组为每 1000 人年 4.05 例（HR：0.98，95%置信区间：0.88-1.09）。逆概率治疗加权调整分析显示，产前 Tdap 疫苗接种与 ASD 风险增加无关（HR：0.85，95%置信区间：0.77-0.95）。
产前 Tdap 疫苗接种与 ASD 风险增加无关。我们支持为孕妇接种疫苗以保护婴儿的建议，因为婴儿在百日咳感染后死亡的风险最高。
