Karolinska Institutet, Stockholm, and Örebro University Hospital, Örebro, Sweden, School of Medicine, University of Nottingham, Nottingham, United Kingdom, and Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, New York (J.F.L.).
Karolinska Institutet, Stockholm, and Uppsala University, Uppsala, Sweden (H.W.).
Ann Intern Med. 2020 Oct 20;173(8):597-604. doi: 10.7326/M20-0167. Epub 2020 Sep 1.
There are concerns that influenza vaccine exposure during pregnancy may be associated with increased risk for autism spectrum disorder (ASD).
To examine the risk for ASD in offspring of mothers who were vaccinated against influenza A(H1N1)pdm09 ("swine flu") during pregnancy.
Population-based cohort study using nationwide registers.
Seven health care regions in Sweden.
Live births between October 2009 and September 2010, with follow-up through December 2016. In total, 39 726 infants were prenatally exposed to H1N1 vaccine (13 845 during the first trimester) and 29 293 infants were unexposed.
Cox regression was used to estimate hazard ratios (HRs) for the primary outcome, ASD, before and after adjustment for potential confounders. The secondary outcome was autistic disorder (AD).
Mean follow-up was 6.7 years in both unexposed and exposed children. During follow-up, 394 (1.0%) vaccine-exposed and 330 (1.1%) unexposed children had a diagnosis of ASD. In adjusted analyses, prenatal exposure to H1N1 vaccination was not associated with a later diagnosis of ASD (adjusted HR [aHR], 0.95 [95% CI, 0.81 to 1.12]) or AD (aHR, 0.96 [CI, 0.80 to 1.16]). The 6-year standardized cumulative incidence difference between the unexposed and exposed children was 0.04% (CI, -0.09% to 0.17%) for ASD and 0.02% (CI, -0.09% to 0.14%) for AD. Restricting the analysis to vaccination in the first trimester of pregnancy did not influence risk estimates (aHR, 0.92 [CI, 0.74 to 1.16] for ASD and 0.91 [CI, 0.70 to 1.18] for AD).
Data on H1N1 influenza infection are lacking.
This large cohort study found no association between maternal H1N1 vaccination during pregnancy and risk for ASD in the offspring.
Swedish Research Council.
有人担心孕妇接种流感疫苗可能会增加自闭症谱系障碍（ASD）的风险。
研究母亲在怀孕期间接种甲型 H1N1pdm09（“猪流感”）流感疫苗后，其子女患 ASD 的风险。
基于人群的队列研究，使用全国性登记处。
瑞典七个医疗保健区。
2009 年 10 月至 2010 年 9 月之间的活产儿，随访至 2016 年 12 月。共有 39726 名婴儿在妊娠期间接受了 H1N1 疫苗接种（13845 人在妊娠早期），29293 名婴儿未接受接种。
使用 Cox 回归估计主要结局（ASD）的风险比（HR），并在调整潜在混杂因素之前和之后进行。次要结局是孤独症（AD）。
未暴露和暴露的儿童平均随访时间均为 6.7 年。在随访期间，394 名（1.0%）疫苗暴露儿童和 330 名（1.1%）未暴露儿童被诊断为 ASD。在调整分析中，产前暴露于 H1N1 疫苗接种与 ASD（调整后的 HR[aHR]，0.95[95%CI，0.81 至 1.12]）或 AD（aHR，0.96[CI，0.80 至 1.16]）的诊断后无相关性。未暴露和暴露儿童的 6 年标准化累积发病率差异为 ASD 为 0.04%（CI，-0.09% 至 0.17%），AD 为 0.02%（CI，-0.09% 至 0.14%）。将分析仅限于妊娠早期的疫苗接种，并不会影响风险估计值（ASD 的 aHR 为 0.92[CI，0.74 至 1.16]，AD 的 aHR 为 0.91[CI，0.70 至 1.18]）。
缺乏关于 H1N1 流感感染的数据。
这项大型队列研究未发现母亲在怀孕期间接种 H1N1 流感疫苗与后代患 ASD 之间存在关联。
瑞典研究理事会。
