Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
Evid Based Ment Health. 2022 May;25(2):54-62. doi: 10.1136/ebmental-2021-300311. Epub 2021 Nov 22.
Antipsychotics are increasingly used among women of childbearing age and during pregnancy.
To determine whether children exposed to antipsychotics are at increased risk of attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD), accounting for maternal diagnoses of bipolar, psychotic and other psychiatric disorders. Population-based cohort study, including a sibling analysis. Nationwide data on all pregnant women and their live-born singletons in Denmark (1997-2017), Finland (1996-2016), Iceland (2004-2017), Norway (2004-2017), and Sweden (2006-2016). 4 324 086 children were eligible for inclusion to the study cohort. Antipsychotic exposure , assessed by pregnancy trimester, type of antipsychotic, and varying patterns of use. Non-mutually exclusive diagnoses of ADHD and ASD. We used Cox proportional hazard models to calculate hazard ratios (HRs) controlling for maternal psychiatric disorders and other potential confounding factors.
Among 4 324 086 singleton births, 15 466 (0.4%) were exposed to antipsychotics . During a median follow-up of 10 years, we identified 72 257 children with ADHD and 38 674 children with ASD. Unadjusted HRs were raised for both outcomes but shifted substantially towards the null after adjustment; 1.10 (95%CI 1.00 to 1.27) for ADHD and 1.12 (0.97 to 1.29) for ASD. Adjusted HRs remained consistent by trimester of exposure and type of antipsychotic. Comparing exposure with pre-pregnancy use yielded HRs of 0.74 (0.62 to 0.87) for ADHD and 0.88 (0.70 to 1.10) for ASD. Sibling analyses yielded HRs of 1.14 (0.79 to 1.64) for ADHD and 1.34 (0.75 to 2.39) for ASD.
Our findings suggest little or no increased risk of child ADHD or ASD after exposure to antipsychotics.
Results regarding child neurodevelopment are reassuring for women who need antipsychotics during pregnancy.
抗精神病药在育龄妇女和妊娠期的使用日益增多。
确定接触抗精神病药的儿童是否患注意缺陷多动障碍（ADHD）或自闭症谱系障碍（ASD）的风险增加，同时考虑到母亲的双相、精神病和其他精神障碍的诊断。这是一项基于人群的队列研究，包括一项同胞分析。该研究在丹麦（1997-2017 年）、芬兰（1996-2016 年）、冰岛（2004-2017 年）、挪威（2004-2017 年）和瑞典（2006-2016 年）的全国范围内，对所有孕妇及其活产单胎进行了研究。4324086 名儿童有资格纳入研究队列。通过妊娠 trimester、抗精神病药类型和不同使用模式评估抗精神病药暴露情况。ADHD 和 ASD 的非互斥诊断。我们使用 Cox 比例风险模型计算风险比（HRs），控制了母亲的精神障碍和其他潜在混杂因素。
在 4324086 例单胎出生中，有 15466（0.4%）例接触过抗精神病药。在中位随访 10 年期间，我们发现有 72257 例儿童患有 ADHD，38674 例儿童患有 ASD。未经调整的 HRs 均升高，但调整后则显著向零值偏移；ADHD 为 1.10（95%CI 1.00 至 1.27），ASD 为 1.12（95%CI 0.97 至 1.29）。根据暴露的 trimester 和抗精神病药的类型，调整后的 HRs 保持一致。与妊娠前使用相比，暴露于 ADHD 的 HRs 为 0.74（0.62 至 0.87），ASD 为 0.88（0.70 至 1.10）。同胞分析的 ADHD HRs 为 1.14（0.79 至 1.64），ASD 为 1.34（0.75 至 2.39）。
我们的研究结果表明，接触抗精神病药后，儿童 ADHD 或 ASD 的风险几乎没有增加或没有增加。
对于在怀孕期间需要抗精神病药物的女性，儿童神经发育方面的结果令人欣慰。
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