在怀孕和注意力缺陷和多动性障碍和自闭症谱系障碍中使用乙氨基
Per Damkier1, Erika B Gram, Michael Ceulemans
1Department of Clinical Pharmacology, Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Clinical Pharmacology & Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; Radboud University Medical Center, Nijmegen, the Netherlands; Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, and the Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; the Pharmacy Department, Rotunda Hospital and School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; the Department of Pediatrics, University of California San Diego, La Jolla, California; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Pharmakovigilanzzentrum, Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany; Mothersafe, University of New South Wales, Australia; UK Teratology Information Service and the Directorate of Women's Services, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom; the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington; the Israeli Teratology Information Service, Ministry of Health, and the Hebrew University Hadassah Medical School, Jerusalem, Israel; the Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida; and the Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.
怀孕期间母亲使用乙氨基不太可能增加孩子患注意力缺陷/多动障碍 (ADHD) 或自闭症谱系障碍 (ASD) 的风险. 目前的证据表明,研究中的偏见表明了联系,而不是真正的临床风险.
科学领域:
- 围产期药理学和神经发育障碍.
背景情况:
- 乙氨基 (偏醇) 是一种在怀孕期间广泛使用的止痛药和抗炎药.
- 对潜在的神经发育影响存在担忧,特别是注意力缺陷/多动障碍 (ADHD) 和自闭症谱系障碍 (ASD),在子宫暴露后.
研究的目的:
- 批判性地评估现有的关于母亲在怀孕期间使用乙氨基与儿童患ADHD和ASD风险之间的关联的科学文献.
- 评估证据的质量,并确定已发表研究中的局限性.
主要方法:
- 对已发表的研究和元分析进行系统审查和批判性评估.
- 纳入标准侧重于具有验证的ADHD或ASD结果定义的研究.
- 分析了九项原始数据研究和三项元分析,特别注意混因素.
主要成果:
- 许多研究报告了乙氨基暴露与ADHD/ASD风险之间的积极关联,这些研究存在重大偏差,包括选择偏差和对混因子的不充分控制.
- 当使用兄弟姐妹分析来解决家族混 (共同的遗传和环境) 时,观察到的关联显著减弱.
- 目前的证据表明,在子宫内对乙氨基的暴露不会导致儿童多动症或自闭症的临床显著增加风险.
结论:
- 现有的科学证据不支持怀孕期间母亲使用乙氨基与儿童患ADHD或ASD风险增加之间的临床重要联系.
- 目前关于在怀孕期间控制疼痛或发烧的临床指南不需要根据这些证据进行修订.
- 需要进一步的前性研究来调查潜在的混因素,包括家庭和心理社会影响对母亲的药物使用和儿童的神经发育.
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