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分娩期间硬膜外镇痛暴露对新生儿自闭症谱系障碍的影响:基于队列研究的系统评价和荟萃分析

Effects of epidural analgesia exposure during parturition on autism spectrum disorder in newborns: A systematic review and meta-analysis based on cohort study.

作者信息

Wang Xiaobo, Li Jie, Liu Dezhao

机构信息

The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.

出版信息

Front Psychiatry. 2022 Sep 6;13:974596. doi: 10.3389/fpsyt.2022.974596. eCollection 2022.

DOI:10.3389/fpsyt.2022.974596
PMID:36147992
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9485435/
Abstract

BACKGROUND

Labor epidural analgesia (LEA) is one of the most effective and widely used approaches for pain relief during parturition. we conducted this meta-analysis to evaluate the association between LEA exposure during parturition and ASD in newborns.

METHODS

PubMed, Cochrane Library, EMBASE and Web of Science database were searched from inception to January 2, 2022 to identify related articles. Literature screening was carried out strictly according to the inclusion and exclusion criteria, and data were extracted and imported into STATA 15.0 software for meta-analysis.

RESULTS

A total of 5 studies with 1763454 participants were included. A statistically significant correlation was observed between LEA and changed ASD (RR = 1.20, 95%CI (1.17, 1.24)), and the correlation between LEA and ASD were analyzed by univariate HR (ES = 1.34, 95%CI(1.27,1.40), < 0.05) and Multivariate HR (ES = 1.13, 95%CI (1.05,1.21), < 0.05).

LIMITATION

First, few studies were included, and most patients were from the United States. Second, the included studies were observational cohort designs, which cannot avoid selection and measurement bias. Third, the results of the included studies were heterogeneous, and a more detailed subgroup analysis was not possible.

CONCLUSION

There is a correlation between LEA during parturition and the risk of ASD in newborns. The Newborn whose mother received LEA during her birth-giving might be more likely to develop ASD.

摘要

背景

分娩硬膜外镇痛(LEA)是分娩期间最有效且应用最广泛的疼痛缓解方法之一。我们进行了这项荟萃分析,以评估分娩期间暴露于LEA与新生儿自闭症谱系障碍(ASD)之间的关联。

方法

检索了PubMed、Cochrane图书馆、EMBASE和Web of Science数据库,从数据库建立至2022年1月2日,以识别相关文章。严格按照纳入和排除标准进行文献筛选,并提取数据,导入STATA 15.0软件进行荟萃分析。

结果

共纳入5项研究,涉及1763454名参与者。观察到LEA与ASD变化之间存在统计学显著相关性(RR = 1.20,95%CI(1.17,1.24)),并通过单因素HR(ES = 1.34,95%CI(1.27,1.40),P < 0.05)和多因素HR(ES = 1.13,95%CI(1.05,1.21),P < 0.05)分析了LEA与ASD之间的相关性。

局限性

首先,纳入的研究较少,且大多数患者来自美国。其次,纳入的研究为观察性队列设计,无法避免选择和测量偏倚。第三,纳入研究的结果存在异质性,无法进行更详细的亚组分析。

结论

分娩期间的LEA与新生儿患ASD的风险之间存在相关性。母亲在分娩时接受LEA的新生儿可能更易患ASD。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf80/9485435/52a1c8dbeadb/fpsyt-13-974596-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf80/9485435/743843b692df/fpsyt-13-974596-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf80/9485435/4d775eb2bbf7/fpsyt-13-974596-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf80/9485435/581d2ba4f232/fpsyt-13-974596-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf80/9485435/1d3a10e37539/fpsyt-13-974596-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf80/9485435/52a1c8dbeadb/fpsyt-13-974596-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf80/9485435/743843b692df/fpsyt-13-974596-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf80/9485435/4d775eb2bbf7/fpsyt-13-974596-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf80/9485435/581d2ba4f232/fpsyt-13-974596-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf80/9485435/1d3a10e37539/fpsyt-13-974596-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf80/9485435/52a1c8dbeadb/fpsyt-13-974596-g006.jpg

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Br J Anaesth. 2022 Mar;128(3):513-521. doi: 10.1016/j.bja.2021.10.042. Epub 2021 Dec 7.
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