Science聚焦抑郁症孕妇的艰难选择:抗抑郁药物和自闭症宝宝
2015/12/17
12月14日,最新一篇发表在《JAMA Pediatrics》期刊的学术文章通过大数据统计证实,患有抑郁症的孕妇在怀孕中后期服用SSRIs类药物,会显著增加所生婴幼儿患自闭症的概率。然而文章发表之初就引起不少流行病学和精神病学专家的质疑。Science官网也对此发文表述,不少专家认为这份最新研究存在漏洞,会引起不必要的社会恐慌。


现代社会发展迅速,经济高速增长背景下,买房、求职、生娃、上学等常规命题让人们生活节奏加快、生活负担加重,甚至于超负荷。由此引发的抑郁症等多种精神类疾病问题也日益突出。据统计,抑郁症目前已成为世界第4大疾病,预估到2020年抑郁症可能成为仅次于心脏病的第2类疾病。

目前,全球最畅销的抗抑郁药物是选择性5-羟色胺再摄取抑制剂(SSRI),包括氟西汀(Prozac ,百忧解)、帕罗西汀(Paroxetine)、氟伏沙明(Floxytral)等。这类药物选择性抑制突触前膜对5-羟色胺(5-HT)的回收,且不影响多巴胺(DA)的再吸收,具有抗抑郁和抗焦虑双重作用。

然而12月14日,最新一篇发表在《JAMA Pediatrics》期刊的学术文章通过大数据统计证实,患有抑郁症的孕妇在怀孕中后期服用SSRIs类药物,会显著增加所生婴幼儿患自闭症的概率。但是,文章发表之初就引起不少流行病学和精神病学专家的质疑。Science官网也对此发文表述,不少专家认为这份最新研究存在漏洞,会引起不必要的社会恐慌。

孕妇服用抗抑郁药物,会显著增加宝宝得自闭症的风险

来自于加拿大蒙特利尔大学围产期流行病学专家Anick Bérard及其研究同事设计并完成了这份研究。他们对1998年1月至2009年12月期间出生于加拿大魁北克省的145,456例婴儿进行了调研,以计算产妇怀孕期间服用SSRI类抗抑郁症药物对所生婴儿患自闭症概率的影响。

结果显示,相比于未曾服药的孕产妇而言,抑郁症孕妇在怀孕中后期服用SSRI类药物,所生宝宝患自闭症概率会增加87%。而且,对于怀孕期间服用两种以上抗抑郁症药物的产妇,她们的孩子患自闭症的风险增加了4倍。

研究人员表示,这些数据意味着,如果身体允许,患有轻微、不严重的抑郁症孕妇应该避免服用SSRI类抗抑郁症药物。Bérard强调,对于轻中度抑郁症孕妇,接受合理的锻炼和心理治疗会比服用药物更为安全可靠。


Science聚焦:对研究结果的质疑和思考


上述研究认为,抑郁症孕产妇服用SSRI类抗抑郁类药物,可能会对胎儿的神经发育造成负面影响,从而增加了孩子患自闭症的概率。

但是,一些科学家对这份研究提出质疑。他们认为,研究论断对自闭症患儿以及患有抑郁症的孕妇而言,都存在误导性,且暗含潜在危险。

众所周知,抑郁症会影响孕妇睡眠质量以及食欲,从而对腹中胎儿带来一定的健康风险。然而,如果研究结论正确——因为母亲服用SSRI类药物,所生宝宝患自闭症概率增加至87%,这意味着儿童患自闭症的绝对概率从原先的1%增加至2%。那么,服用抑郁症药物缓解孕妇症状、保障睡眠饮食等质量的意义就没有了。

哈佛大学精神病遗传学家Roy Perlis表示,最新研究存在“关键漏洞”:研究人员并没有对调查对象的抑郁症程度进行科学评估,从而无法论断患自闭症的孩子之所以得病,是因为母亲怀孕期间服用了药物,还是因为母亲怀孕期间患有精神类药物。

他强调,之前多篇学术论文已经证实,孕妇抑郁症病情得到控制后,孩子患自闭症的风险不会增加。所以,他认为,孩子患自闭症的高风险是因为其母亲患病,而不是因为服用药物。

事实上,SSRI药物及其他抗抑郁症药物是否会影响胎儿的神经发育,仍然缺乏有力证据。而SSRI药物确实能够缓解孕妇的抑郁症症状。所以,抑郁症药物是否导致自闭症,以及如何治疗抑郁症孕妇难题亟需攻克,对控制自闭症、抑郁症治疗有着重要的临床意义。
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  • Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children

    Importance The association between the use of antidepressants during gestation and the risk of autism spectrum disorder (ASD) in children is still controversial. The etiology of ASD remains unclear, although studies have implicated genetic predispositions, environmental risk factors, and maternal depression. Objective To examine the risk of ASD in children associated with antidepressant use during pregnancy according to trimester of exposure and taking into account maternal depression. Design, Setting, and Participants We conducted a register-based study of an ongoing population-based cohort, the Québec Pregnancy/Children Cohort, which includes data on all pregnancies and children in Québec from January 1, 1998, to December 31, 2009. A total of 145 456 singleton full-term infants born alive and whose mothers were covered by the Régie de l’assurance maladie du Québec drug plan for at least 12 months before and during pregnancy were included. Data analysis was conducted from October 1, 2014, to June 30, 2015. Exposures Antidepressant exposure during pregnancy was defined according to trimester and specific antidepressant classes. Main Outcomes and Measures Children with ASD were defined as those with at least 1 diagnosis of ASD between date of birth and last date of follow-up. Cox proportional hazards regression models were used to estimate crude and adjusted hazard ratios with 95% CIs. Results During 904 035.50 person-years of follow-up, 1054 children (0.7%) were diagnosed with ASD; boys with ASD outnumbered girls by a ratio of about 4:1. The mean (SD) age of children at the end of follow-up was 6.24 (3.19) years. Adjusting for potential confounders, use of antidepressants during the second and/or third trimester was associated with the risk of ASD (31 exposed infants; adjusted hazard ratio, 1.87; 95% CI, 1.15-3.04). Use of selective serotonin reuptake inhibitors during the second and/or third trimester was significantly associated with an increased risk of ASD (22 exposed infants; adjusted hazard ratio, 2.17; 95% CI, 1.20-3.93). The risk was persistent even after taking into account maternal history of depression (29 exposed infants; adjusted hazard ratio, 1.75; 95% CI, 1.03-2.97). Conclusions and Relevance Use of antidepressants, specifically selective serotonin reuptake inhibitors, during the second and/or third trimester increases the risk of ASD in children, even after considering maternal depression. Further research is needed to specifically assess the risk of ASD associated with antidepressant types and dosages during pregnancy.

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