怀孕晚期抗发作药物暴露和后代神经发育风险:一个多儿童队列研究
Odile Sheehy1, Vanina Tchuente1, Sherif Eltonsy2
1CHU Sainte-Justine, Research Center, Montreal, Canada.
Annals of neurology
|November 28, 2025
概括
产前接触抗发作药物 (ASM) 与儿童神经发育障碍 (NDD) 的风险更高有关. 这种关联强调了需要仔细考虑怀孕期间使用ASM的必要性.
科学领域:
- 神经科学是一个神经科学.
- 发育儿科 发育儿科
- 药理学 药理学是指药理学的学科.
背景情况:
- 怀孕期间抗发作药物 (ASM) 的使用量有所增加,但其对后代神经发育的影响仍然存在争议.
- 关于产前ASM暴露和神经发育障碍 (NDD) 的现有证据是不一致的.
- 这项研究解决了关于产前ASM暴露与NDD之间关联的更清晰数据的需求.
研究的目的:
- 评估产前接触抗发作药物 (ASM) 与儿童神经发育障碍 (NDD) 风险之间的关联.
- 分析来自加拿大和美国的大型,基于人口的母婴队列的数据.
- 提供关于ASM在孕妇中使用的知情决策的证据.
主要方法:
- 对5个基于人口的队列 (加拿大母婴队列[CAMCCO]和AM-PREGNANT) 的分析.
- 根据母体处方定义的ASM暴露填充在出生前60天内.
- 使用基于ICD-9/10代码的验证算法识别NDD;使用Cox比例危险模型和元分析.
主要成果:
- 在2,910,206名儿童中,0.47%的产前ASM暴露与NDD风险增加29%有关 (聚合调整的危险比率[p-aHR]:1.29).
- 特定的ASM显示出不同的风险:卡巴马泽平 (p-aHR:1.50),克洛纳泽帕姆 (p-aHR:1.22),托皮拉玛 (p-aHR:1.56) 和瓦尔酸 (p-aHR:1.38).
- 多疗法呈现出比单疗法更高风险的趋势,但这在统计学上并不显著.
结论:
- 产前暴露于某些ASM与后代的NDD风险增加有着一致的联系.
- 这些发现强调了在怀孕期间使用ASM进行个性化风险益处评估的重要性.
- 谨慎的决策至关重要,以减轻潜在的神经发育风险在儿童暴露在ASMs产前.
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