产前皮质类固醇治疗与儿童精神和行为障碍之间的关联
Katri Räikkönen1, Mika Gissler2,3,4, Eero Kajantie5,6,7,8
1Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
JAMA
|May 20, 2020
概括
孕产前使用皮质类固醇治疗,使胎儿肺部成熟,与儿童患精神和行为障碍的风险较高有关. 这种联系甚至在比较兄弟姐妹时也存在, 这表明了家庭因素之外的直接影响.
科学领域:
- 产周医学
- 发展心理学
- 儿童神经病学
背景情况:
- 产前皮质固醇治疗是早产风险的标准.
- 由于长期结果数据有限,对超过34周的怀孕的使用仍有争议.
- 对于在子宫中暴露的早产婴儿的长期影响还没有得到充分研究.
研究的目的:
- 调查母亲产前皮质类固醇治疗与儿童精神/行为障碍之间的关联.
- 为了比较期满 (≥37周) 和早产 (<37周) 婴儿的结果.
- 评估这些关联中未测量的家庭混的作用.
主要方法:
- 基于人口的回顾性队列研究,使用芬兰全国性注册表.
- 包括2006年至2017年间的单生婴儿,追踪到2017年.
- 为了控制家族因素,使用了兄弟姐妹内部分析.
主要成果:
- 在整个队列中,产前皮质类固醇暴露与精神/行为障碍的显著更高风险有关 (HR 1. 33).
- 这种关联在满期出生的儿童 (HR 1.47) 和不一致的兄弟姐妹 (HR 1.38) 中显著.
- 虽然暴露于早产儿的发病率较高,但危险比率并不显著 (HR 1. 00).
结论:
- 产前皮质固醇治疗与儿童精神和行为障碍的风险显著增加有关.
- 这些发现表明治疗的潜在直接效应,独立于家族混.
- 结果可以为临床决策提供信息,以扩大产前皮质类固醇的使用范围.
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