Kapra Ori, Rotem Ran, Gross Raz
Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel-Aviv, Israel.
School of Public Health, Harvard University, Boston, MA, United States.
Front Psychiatry. 2020 Nov 23;11:555740. doi: 10.3389/fpsyt.2020.555740. eCollection 2020.
Use of antidepressants (ADs) in general, and in pregnant notwithstanding, has been increasing globally in recent decades. Associations with a wide range of adverse perinatal and childhood outcomes following prenatal ADs exposure have been observed in registry-based studies, with Autism Spectrum Disorders (ASD) frequently reported. Studies using animal models, sibling analyses, and negative control approaches, have linked dysfunctional serotonin metabolism with ASD, but did not convincingly tease apart the role of maternal mental health from that of ADs. As work to decipher the nature of the AD-ASD association continues, this review raises some public health concerns pertinent to a hypothetical conclusion that this association is causal, including the need to identify specific gestation periods with higher risk, the importance of precise assessment of the ASD potential prevention that might be attributed to AD discontinuation, and the estimation of risks associated with prenatal exposure to untreated depression.
近几十年来，全球范围内抗抑郁药（ADs）的使用，包括在孕妇中的使用，一直在增加。基于登记处的研究观察到，产前暴露于抗抑郁药后会出现一系列不良围产期和儿童期结局，其中自闭症谱系障碍（ASD）的报告频率较高。使用动物模型、同胞分析和阴性对照方法的研究将血清素代谢功能障碍与自闭症谱系障碍联系起来，但并未令人信服地将母亲心理健康的作用与抗抑郁药的作用区分开来。随着破解抗抑郁药与自闭症谱系障碍关联本质的工作继续进行，本综述提出了一些与这种关联是因果关系这一假设结论相关的公共卫生问题，包括识别高风险特定妊娠期的必要性、精确评估可能归因于停用抗抑郁药的自闭症谱系障碍潜在预防措施的重要性，以及估计产前暴露于未经治疗的抑郁症相关风险。
