Aperçu: G.M.
Les observations antérieures d'un risque plus élevé de troubles du
spectre de l'autisme chez les enfants avec une exposition aux
antidépresseurs sérotonergiques pendant la grossesse peuvent avoir été
confondues. L'étude propose d'évaluer l'association entre l'exposition aux antidépresseurs
sérotonergiques pendant la grossesse et le trouble du spectre de
l'autisme de l'enfant.
Il
y avait 35906 naissances isolées à un âge gestationnel moyen de 38,7
semaines (50,4% étaient des hommes, l'âge maternel moyen était de 26,7
ans et la durée moyenne de suivi était de 4,95 ans). Parmi les 2837 grossesses (7,9%) exposées aux antidépresseurs, 2,0% (IC à
95%, 1,6% -2,6%) des enfants ont été diagnostiqués avec un trouble du
spectre de l'autisme. L'incidence
du trouble du spectre de l'autisme était de 4,51 pour 1000 ans-personne
parmi les enfants exposés aux antidépresseurs contre 2,03 pour 1000
personnes chez les enfants non exposés.
Chez
les enfants nés de mères ayant un régime public de délivrance de médicaments en
Ontario, au Canada, l'exposition aux antidépresseurs sérotonergiques
chez l'utérus contre l'absence d'exposition n'a pas été associée au trouble du
spectre de l'autisme chez l'enfant. Bien qu'une relation causale ne puisse pas être exclue, l'association précédemment observée s'explique par d'autres facteurs.
JAMA. 2017 Apr 18;317(15):1544-1552. doi: 10.1001/jama.2017.3415.
- 1
- Women's
College Research Institute, Women's College Hospital, Toronto, Ontario,
Canada2Department of Psychiatry, University of Toronto, Toronto,
Ontario, Canada3Institute for Clinical Evaluative Sciences, Toronto,
Ontario, Canada.
- 2
- Institute for Clinical Evaluative
Sciences, Toronto, Ontario, Canada4Department of Obstetrics and
Gynaecology, St Michael's Hospital, Toronto, Ontario, Canada5Department
of Medicine, University of Toronto, Toronto, Ontario, Canada.
- 3
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
- 4
- Department
of Psychiatry, University of Toronto, Toronto, Ontario,
Canada3Institute for Clinical Evaluative Sciences, Toronto, Ontario,
Canada6Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- 5
- Institute
for Clinical Evaluative Sciences, Toronto, Ontario, Canada7Leslie Dan
Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
Abstract
Importance:
Previous observations of a higher risk of child autism spectrum disorder with serotonergic antidepressant exposure during pregnancy may have been confounded.
Objective:
To evaluate the association between serotonergic antidepressant exposure during pregnancy and child autism spectrum disorder.
Design, Setting, and Participants:
Retrospective
cohort study. Health administrative data sets were used to study
children born to mothers who were receiving public prescription drug
coverage during pregnancy in Ontario, Canada, from 2002-2010, reflecting
4.2% of births. Children were followed up until March 31, 2014.
Exposures:
Serotonergic
antidepressant exposure was defined as 2 or more consecutive maternal
prescriptions for a selective serotonin or serotonin-norepinephrine
reuptake inhibitor between conception and delivery.
Main Outcomes and Measures:
Child autism spectrum disorder
identified after the age of 2 years. Exposure group differences were
addressed by inverse probability of treatment weighting based on derived
high-dimensional propensity scores (computerized algorithm used to
select a large number of potential confounders) and by comparing exposed
children with unexposed siblings.
Results:
There
were 35 906 singleton births at a mean gestational age of 38.7 weeks
(50.4% were male, mean maternal age was 26.7 years, and mean duration of
follow-up was 4.95 years). In the 2837 pregnancies (7.9%) exposed to
antidepressants, 2.0% (95% CI, 1.6%-2.6%) of children were diagnosed
with autism spectrum disorder. The incidence of autism spectrum disorder
was 4.51 per 1000 person-years among children exposed to
antidepressants vs 2.03 per 1000 person-years among unexposed children
(between-group difference, 2.48 [95% CI, 2.33-2.62] per 1000
person-years; hazard ratio [HR], 2.16 [95% CI, 1.64-2.86]; adjusted HR,
1.59 [95% CI, 1.17-2.17]). After inverse probability of treatment
weighting based on the high-dimensional propensity score, the
association was not significant (HR, 1.61 [95% CI, 0.997-2.59]). The
association was also not significant when exposed children were compared
with unexposed siblings (incidence of autism spectrum disorder was 3.40 per 1000 person-years vs 2.05 per 1000 person-years, respectively; adjusted HR, 1.60 [95% CI, 0.69-3.74]).
Conclusions and Relevance:
In
children born to mothers receiving public drug coverage in Ontario,
Canada, in utero serotonergic antidepressant exposure compared with no
exposure was not associated with autism spectrum disorder
in the child. Although a causal relationship cannot be ruled out, the
previously observed association may be explained by other factors.
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