L'utilisation d'antidépresseur pendant la grossesse et le risque de "trouble du spectre de l'autisme" et le trouble d'hyperactivité avec déficit de l'attention: revue systématique des études d'observation et considérations méthodologiques

Aperçu: G.M.

L'exposition aux antidépresseurs pendant la grossesse a été associée à un risque accru de "trouble du spectre de l'autisme" (TSA) et de trouble d'hyperactivité avec déficit de l'attention (TDAH) dans plusieurs études observationnelles. Les chercheurs ont effectué un examen systématique de ces études afin de mettre en évidence l'effet que de telles limites méthodologiques importantes ont sur ces analyses et d'envisager des approches pour la conduite, la communication et l'interprétation des études futures.Une revue de MEDLINE et d'EMBASE a identifié des études de cas-témoins, cohortes et fratries évaluant le risque de TSA et de TDAH avec prise d'un antidépresseur pendant la grossesse.
Un total de 15 études mesurant les TSA en tant que résultat (impliquant 3 585 686 enfants et 40 585 cas) et 7 études mesurant le TDAH comme résultat (impliquant 2 765 723 patients et 52 313 cas) ont été identifiées. Une variation de l'ajustement confusionnel existait entre les études. Les estimations des effets mis à jour pour l'association entre l'exposition des antidépresseurs maternels pendant la grossesse à toutes les femmes non exposées restaient statistiquement significatives pour les TSA (rapport des risques aléatoires ajusté [RaRR] 1,53, intervalle de confiance à 95% [IC] 1,31-1,78).  

Des associations significatives similaires ont été observées avec l'exposition aux antidépresseurs maternels avant la grossesse (RaRR 1,48, IC 95% 1,29-1,71) et l'exposition aux antidépresseurs paternels pendant la grossesse (1,29, IC à 95% 1,08-1,53), mais les analyses ont été limitées aux femmes ayant des antécédents de trouble affectif (1,18, IC 95% 0,91-1,52) et les études de fratries (0,96, IC 95% 0,65-1,42) n'étaient pas statistiquement significatives. 

Les associations correspondantes pour le risque de TDAH avec exposition étaient: RaRR 1,38, IC à 95% 1,13-1,69 (pendant la grossesse), RaRR 1,38, IC à 95% 1,14-1,69 (avant la grossesse), RaRR 1,71, IC à 95% 1,31-2,23 ( exposition paternelle), RaRR 0,98, IC à 95% 0,77-1,24 (femmes ayant des antécédents de trouble affectif) et RaRR 0,88, IC à 95% 0,70-1,11 (études de fratries).Les études observationnelles existantes mesurant le risque de TSA et de TDAH avec une exposition aux antidépresseurs sont hétérogènes dans leur conception. Les comparaisons classiques entre les femmes exposées et non exposées pendant la grossesse présentent un risque élevé de confusion résiduelle. 

 Des comparaisons alternatives et des conceptions fraternelles peuvent faciliter l'interprétation de la causalité et leur utilité nécessite une évaluation plus approfondie, y compris la compréhension des limites potentielles de la réalisation de méta-analyses avec de telles données.

Cliquer ICI pour accéder à l'intégralité de l'article en anglais 

BMC Med. 2018 Jan 15;16(1):6. doi: 10.1186/s12916-017-0993-3.

Antidepressant use during pregnancy and risk of autism spectrum disorder and attention deficit hyperactivity disorder: systematic review of observational studies and methodological considerations

Morales DR^1,2, Slattery J³, Evans S⁴, Kurz X³.

Author information

1

Pharmacovigilance and Epidemiology Department, European Medicines Agency, 30 Churchill Place, Canary Wharf, London, E14 5EU, UK. Daniel.Morales@ema.europa.eu.

2

Division of Population Health Sciences, University of Dundee, Dundee, UK. Daniel.Morales@ema.europa.eu.

3

Pharmacovigilance and Epidemiology Department, European Medicines Agency, 30 Churchill Place, Canary Wharf, London, E14 5EU, UK.

4

Department of Medical Statistics, London School of Hygiene and Tropical Medicine, University of London, London, UK.

Abstract

BACKGROUND:

Antidepressant exposure during pregnancy has been associated with an increased risk of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) in several observational studies. We performed a systematic review of these studies to highlight the effect that important methodological limitations have on such analyses and to consider approaches to the conduct, reporting and interpretation of future studies.

METHODS:

A review of MEDLINE and EMBASE identified case-control, cohort and sibling studies assessing the risk of ASD and ADHD with antidepressant use during pregnancy. Approaches to confounding adjustment were described. Crude and adjusted effect estimates for comparisons between antidepressant exposure during pregnancy vs. all unexposed women were first meta-analysed using a generic inverse variance method of analysis, followed by effect estimates for alternative pre-selected comparison groups.

RESULTS:

A total of 15 studies measuring ASD as an outcome (involving 3,585,686 children and 40,585 cases) and seven studies measuring ADHD as an outcome (involving 2,765,723 patients and 52,313 cases) were identified. Variation in confounding adjustment existed between studies. Updated effect estimates for the association between maternal antidepressant exposure during pregnancy vs. all unexposed women remained statistically significant for ASD (adjusted random-effects risk ratio [RaRR] 1.53, 95% confidence interval [CI] 1.31-1.78). Similar significant associations were observed using pre-pregnancy maternal antidepressant exposure (RaRR 1.48, 95% CI 1.29-1.71) and paternal antidepressant exposure during pregnancy (1.29, 95% CI 1.08-1.53), but analyses restricted to using women with a history of affective disorder (1.18, 95% CI 0.91-1.52) and sibling studies (0.96, 95% CI 0.65-1.42) were not statistically significant. Corresponding associations for risk of ADHD with exposure were: RaRR 1.38, 95% CI 1.13-1.69 (during pregnancy), RaRR 1.38, 95% CI 1.14-1.69 (during pre-pregnancy), RaRR 1.71, 95% CI 1.31-2.23 (paternal exposure), RaRR 0.98, 95% CI 0.77-1.24 (women with a history of affective disorder) and RaRR 0.88, 95% CI 0.70-1.11 (sibling studies).

CONCLUSIONS:

Existing observational studies measuring the risk of ASD and ADHD with antidepressant exposure are heterogeneous in their design. Classical comparisons between exposed and unexposed women during pregnancy are at high risk of residual confounding. Alternative comparisons and sibling designs may aid the interpretation of causality and their utility requires further evaluation, including understanding potential limitations of undertaking meta-analyses with such data.

PMID:29332605

DOI:10.1186/s12916-017-0993-3

Risque d'autisme après un antidépresseur pendant la grossesse

Aperçu: G.M.

Les médicaments avec des antidépresseurs pendant la grossesse ne semblent pas être associés à un risque accru de TSA chez la progéniture. Au lieu de cela, les résultats suggèrent que l'association s'explique par des facteurs liés à la susceptibilité sous-jacente aux troubles psychiatriques. Sur la base de ces résultats, le risque de TSA chez la progéniture ne devrait pas être pris en considération pour refuser le traitement avec des antidépresseurs couramment utilisés chez les femmes enceintes.

Psychol Med. 2017 May 22:1-10. doi: 10.1017/S0033291717001301.

Autism risk following antidepressant medication during pregnancy

Viktorin A¹, Uher R², Reichenberg A¹, Levine SZ³, Sandin S¹.

Author information

1

Department of Psychiatry,Icahn School of Medicine,Mount Sinai,New York, NY,USA.

2

Department of Psychiatry,Dalhousie University,Halifax,Nova Scotia,Canada.

3

Department of Community Mental Health,University of Haifa,Haifa,Israel.

Abstract

BACKGROUND:

Previous studies have examined if maternal antidepressant medication during pregnancy increase the risk of autism spectrum disorder (ASD) in the offspring, but the results have been conflicting.

METHODS:

In a population-based cohort of 179 007 children born in 2006 and 2007 and followed through 2014 when aged 7 and 8, we estimated relative risks (RRs) of ASD and 95% confidence intervals (CIs) from Cox regression in children exposed to any antidepressant medication during pregnancy, and nine specific antidepressant drugs. Analyses were adjusted for potential confounders and were conducted in the full population sample, and in a clinically relevant sub-sample of mothers with at least one diagnosis of depression or anxiety during life.

RESULTS:

The adjusted RR of ASD in children of mothers who used antidepressant medication during pregnancy was estimated at 1.23 (95% CI 0.96-1.57), and at 1.07 (95% CI 0.80-1.43) in women with a history of depression or anxiety. Analyses of specific antidepressants initially revealed increased RRs of offspring ASD confined to citalopram and escitalopram (RR: 1.47; 95% CI 0.92-2.35) and clomipramine (RR: 2.86; 95% CI 1.04-7.82).

CONCLUSION:

Medication with antidepressants during pregnancy does not appear to be causally associated with an increased risk of ASD in the offspring. Instead, the results suggest that the association is explained by factors related to the underlying susceptibility to psychiatric disorders. Based on these findings, the risk of ASD in the offspring should not be a consideration to withhold treatment with commonly used antidepressant drugs from pregnant women.

PMID: 28528584

DOI: 10.1017/S0033291717001301

Associations d'utilisation d'antidépresseurs maternels pendant le premier trimestre de grossesse avec naissance prématurée, faible âge gestationnel, trouble du spectre de l'autisme et trouble déficitaire de l'attention/hyperactivité chez les enfants

Aperçu: G.M.

L'exposition aux antidépresseurs prénataux a été associée à des résultats défavorables.

L'étude a évalué différentes hypothèses pour les associations entre l'exposition aux antidépresseurs au premier trimestre et les problèmes de naissance et de développement neurologique.

Les mesures portent sur la naissance prématurée (<37 semaines de gestation), le faible âge gestationnel (poids de la naissance <2 SD en dessous de la moyenne pour l'âge gestationnel) et le premier diagnostic clinique d'hospitalisation ou de diagnostic ambulatoire du trouble du spectre de l'autisme et du trouble déficitaire de l'attention / hyperactivité chez les descendants. 

Parmi les descendants nés en Suède, après avoir tenu compte des facteurs de confusion, l'exposition aux antidépresseurs au premier trimestre , par rapport à l'absence d'exposition, a été associée à un faible risque accru de naissance prématurée, mais l'exposition aux antidépresseurs au premier trimestre n'a été associé à aucun risque accru de trouble du spectre de l'autisme,  de faible âge gestationnel, ou de déficit d''attention / hyperactivité.

JAMA. 2017 Apr 18;317(15):1553-1562. doi: 10.1001/jama.2017.3413.

Associations of Maternal Antidepressant Use During the First Trimester of Pregnancy With Preterm Birth, Small for Gestational Age, Autism Spectrum Disorder, and Attention-Deficit/Hyperactivity Disorder in Offspring

Sujan AC¹, Rickert ME¹, Öberg AS², Quinn PD¹, Hernández-Díaz S³, Almqvist C⁴, Lichtenstein P⁴, Larsson H⁵, D'Onofrio BM⁶.

Author information

1

Department of Psychological and Brain Sciences, Indiana University, Bloomington.

2

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden3Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

3

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

4

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

5

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden4School of Medical Sciences, Örebro University, Örebro, Sweden.

6

Department of Psychological and Brain Sciences, Indiana University, Bloomington2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

Abstract

Importance:

Prenatal antidepressant exposure has been associated with adverse outcomes. Previous studies, however, may not have adequately accounted for confounding.

Objective:

To evaluate alternative hypotheses for associations between first-trimester antidepressant exposure and birth and neurodevelopmental problems.

Design, Setting, and Participants:

This retrospective cohort study included Swedish offspring born between 1996 and 2012 and followed up through 2013 or censored by death or emigration. Analyses controlling for pregnancy, maternal and paternal covariates, as well as sibling comparisons, timing of exposure comparisons, and paternal comparisons, were used to examine the associations.

Exposures:

Maternal self-reported first-trimester antidepressant use and first-trimester antidepressant dispensations.

Main Outcomes and Measures:

Preterm birth (<37 gestational weeks), small for gestational age (birth weight <2 SDs below the mean for gestational age), and first inpatient or outpatient clinical diagnosis of autism spectrum disorder and attention-deficit/hyperactivity disorder in offspring.

Results:

Among 1 580 629 offspring (mean gestational age, 279 days; 48.6% female; 1.4% [n = 22 544] with maternal first-trimester self-reported antidepressant use) born to 943 776 mothers (mean age at childbirth, 30 years), 6.98% of exposed vs 4.78% of unexposed offspring were preterm, 2.54% of exposed vs 2.19% of unexposed were small for gestational age, 5.28% of exposed vs 2.14% of unexposed were diagnosed with autism spectrum disorder by age 15 years, and 12.63% of exposed vs 5.46% of unexposed were diagnosed with attention-deficit/hyperactivity disorder by age 15 years. At the population level, first-trimester exposure was associated with all outcomes compared with unexposed offspring (preterm birth odds ratio [OR], 1.47 [95% CI, 1.40-1.55]; small for gestational age OR, 1.15 [95% CI, 1.06-1.25]; autism spectrum disorder hazard ratio [HR], 2.02 [95% CI, 1.80-2.26]; attention-deficit/hyperactivity disorder HR, 2.21 [95% CI, 2.04-2.39]). However, in models that compared siblings while adjusting for pregnancy, maternal, and paternal traits, first-trimester antidepressant exposure was associated with preterm birth (OR, 1.34 [95% CI, 1.18-1.52]) but not with small for gestational age (OR, 1.01 [95% CI, 0.81-1.25]), autism spectrum disorder (HR, 0.83 [95% CI, 0.62-1.13]), or attention-deficit/hyperactivity disorder (HR, 0.99 [95% CI, 0.79-1.25]). Results from analyses assessing associations with maternal dispensations before pregnancy and with paternal first-trimester dispensations were consistent with findings from the sibling comparisons.

Conclusions and Relevance:

Among offspring born in Sweden, after accounting for confounding factors, first-trimester exposure to antidepressants, compared with no exposure, was associated with a small increased risk of preterm birth but no increased risk of small for gestational age, autism spectrum disorder, or attention-deficit/hyperactivity disorder.

PMID: 28418479

DOI: 10.1001/jama.2017.3413

Association entre l'utilisation d'antidépresseurs sérotonergiques pendant la grossesse et le trouble du spectre de l'autisme chez les enfants

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.

Association Between Serotonergic Antidepressant Use During Pregnancy and Autism Spectrum Disorder in Children

Brown HK¹, Ray JG², Wilton AS³, Lunsky Y⁴, Gomes T⁵, Vigod SN¹.

Author information

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.

PMID: 28418480 

DOI: 10.1001/jama.2017.3415

Risque de troubles du spectre de l'autisme selon la période d'exposition aux antidépresseurs prénatals: un examen systématique et une méta-analyse

Aperçu: G.M.

Il existe une association significative entre l'augmentation du risque de TSA et l'utilisation maternelle des antidépresseurs pendant la grossesse; Cependant, il semble être plus cohérent pendant la période de préconception que pendant chaque trimestre. Les troubles psychiatriques maternels dans le traitement avant la grossesse plutôt que l'exposition prénatale aux antidépresseurs pourraient avoir un rôle majeur dans le risque de TSA.

JAMA Pediatr. 2017 Apr 17. doi: 10.1001/jamapediatrics.2017.0124.

Risk for Autism Spectrum Disorders According to Period of Prenatal Antidepressant Exposure: A Systematic Review and Meta-analysis

Mezzacappa A¹, Lasica PA¹, Gianfagna F², Cazas O¹, Hardy P³, Falissard B⁴, Sutter-Dallay AL⁵, Gressier F³.

Author information

1

Department of Psychiatry, Assistance Publique-Hôpitaux de Paris, Bicêtre University Hospital, Le Kremlin Bicêtre, France.

2

EPIMED Research Centre-Epidemiology and Preventive Medicine, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy3Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy.

3

Department of Psychiatry, Assistance Publique-Hôpitaux de Paris, Bicêtre University Hospital, Le Kremlin Bicêtre, France4Université Paris-Saclay, Univ Paris-Sud, UVSQ, CESP, INSERM U1178, Bicêtre University Hospital, Le Kremlin Bicêtre, France.

4

Université Paris-Saclay, Univ Paris-Sud, UVSQ, CESP, INSERM U1178, Department of Biostatistics, Maison de Solenn, Paris, France.

5

Research Center INSERM 1219, Bordeaux Population Health Bordeaux University, University Department of Adult Psychiatry, Charles-Perrens Hospital, Bordeaux, France.

Abstract

Importance:

Several studies have examined the links between prenatal exposure to antidepressants and autism spectrum disorders (ASDs) in children, with inconsistent results, especially regarding the impact of the trimester of exposure.

Objective:

To perform a systematic review of the literature and a meta-analysis of published studies to assess the association between ASDs and fetal exposure to antidepressants during pregnancy for each trimester of pregnancy and preconception.

Data Sources:

PubMed, EMBASE, and PsycINFO databases up to May 2016 were searched in June 2016 for observational studies. For the meta-analyses, data were analyzed on RevMan version 5.2 using a random-effect model. For the review, studies were included if they had been published and were cohort or case-control studies, and for the meta-analysis, studies were included if they were published studies and the data were not derived from the same cohorts.

Study Selection:

We included all the studies that examined the association between ASDs and antenatal exposure to antidepressants.

Data Extraction and Synthesis:

Three reviewers independently screened titles and abstracts, read full-text articles, and extracted data. The quality of the studies was also assessed.

Main Outcomes and Measures:

Primary outcome was the association between antidepressants during pregnancy and ASDs. Secondary outcomes were the associations between antidepressants in each individual trimester or before pregnancy and ASDs.

Results:

Our literature search identified 10 relevant studies with inconsistent results. For prenatal exposure, the meta-analysis on the 6 case-control studies (117 737 patients) evidenced a positive association between antidepressant exposure and ASDs (odds ratio [OR], 1.81; 95% CI, 1.49-2.20). The association was weaker when controlled for past maternal mental illness (OR, 1.52; 95% CI, 1.09-2.12). A similar pattern was found whatever the trimester of exposure considered (first trimester: OR, 2.09, 95% CI,1.66-2.64; second: OR, 2.00, 95% CI, 1.55-2.59; and third: OR, 1.90, 95% CI, 1.20-3.02. Controlled for past maternal mental illness: first trimester: OR, 1.79; 95% CI, 1.27-2.52, second: OR, 1.67, 95% CI, 1.14-2.45; and third: OR, 1.54, 95% CI, 0.82-2.90). No association was found when the 2 cohort studies were pooled (772 331 patients) for the whole pregnancy (hazard ratio, 1.26; 95% CI, 0.91-1.74) or for the first trimester. In addition, preconception exposure to antidepressants was significantly associated with an increased risk for ASDs (OR controlled for past maternal illness, 1.77; 95% CI, 1.49-2.09).

Conclusions and Relevance:

There is a significant association between increased ASD risk and maternal use of antidepressants during pregnancy; however, it appears to be more consistent during the preconception period than during each trimester. Maternal psychiatric disorders in treatment before pregnancy rather than antenatal exposure to antidepressants could have a major role in the risk for ASDs. Future studies should address the problem of this potential confounder.

PMID: 28418571

DOI: 10.1001/jamapediatrics.2017.0124

Antidepressant exposure in pregnancy and risk of autism spectrum disorders

Traduction: G.M.

Clin Epidemiol. 2013 Nov 15;5:449-459.

Exposition aux antidépresseurs pendant la grossesse et risque de troubles du spectre autistique

Sørensen MJ, Grønborg TK, Christensen J, Parner ET, Vestergaard M, Schendel D, Pedersen LH.

Source

Regional Centre of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark.

Abstract

Sørensen MJ , Grønborg savoirs traditionnels , Christensen J , Parner ET , Vestergaard M , D Schendel , Pedersen LH .Source
Centre régional de pédopsychiatrie de l'hôpital universitaire d'Aarhus , Risskov , Danemark .

CONTEXTE 

L'utilisation des antidépresseurs pendant la grossesse et la prévalence des troubles du spectre de l'autisme ont augmenté ensemble au cours des dernières années . Un lien de causalité a été suggéré récemment , mais l'association peut être confondue par l'indication sous-jacente de l'utilisation des antidépresseurs . Nous avons étudié l' association entre la consommation maternelle d'antidépresseurs pendant la grossesse et l'autisme , en contrôlant les facteurs de confusion potentiels . 

MÉTHODES

Nous avons identifié tous les enfants nés vivants au Danemark 1996-2006 ( n = 668 468 ) et de leurs parents dans le Danish Civil Registration System . Nous avons obtenu des informations sur les prescriptions de la mère pendant la grossesse remplis à partir du Danish National Prescription Registry , et sur ​​les diagnostics de troubles du spectre de l'autisme chez les enfants et les diagnostics de troubles psychiatriques chez les parents du Danish Psychiatric Central Registerl .  
Dans une analyse de cohorte , nous avons estimé les ratios liés au hasard des troubles du spectre autistique chez les enfants exposés aux antidépresseurs pendant la grossesse par rapport aux enfants qui n'ont pas été exposés , en utilisant une analyse de régression proportionnelle du au hasard. En outre , nous avons estimé le risque de trouble du spectre autistique dans un modèle avec la fratrie.

RÉSULTATS

Les enfants exposés avant la naissance aux antidépresseurs avaient un risque relatif ajusté de 1,5 ( 95 % intervalle de confiance [ IC ] 1.2 à 1.9 ) pour les troubles du spectre de l'autisme par rapport aux enfants non exposés.  
En limitant l'analyse aux enfants de femmes ayant reçu un diagnostic de trouble affectif , le hazard ratio ajusté était de 1,2 (IC 95% 0,7 à 2,1 ) , et le risque a été réduit lorsque les enfants exposés ont été comparés avec leurs frères et sœurs non exposées ( hazard ratio ajusté 1,1 ; IC à 95% 0,5-2,3 ) . 

CONCLUSION

Après contrôle des facteurs de confusion importants , il n'y avait pas d'association significative entre l'exposition prénatale à des médicaments antidépresseurs et des troubles du spectre autistique chez la progéniture .
 

BACKGROUND:Both the use of antidepressant medication during pregnancy and the prevalence of autism spectrum disorder have increased during recent years. A causal link has recently been suggested, but the association may be confounded by the underlying indication for antidepressant use. We investigated the association between maternal use of antidepressant medication in pregnancy and autism, controlling for potential confounding factors.
METHODS:We identified all children born alive in Denmark 1996-2006 (n=668,468) and their parents in the Danish Civil Registration System. We obtained information on the mother's prescriptions filled during pregnancy from the Danish National Prescription Registry, and on diagnoses of autism spectrum disorders in the children and diagnoses of psychiatric disorders in the parents from the Danish Psychiatric Central Register. In a cohort analysis, we estimated hazard ratios of autism spectrum disorders in children exposed to antidepressant medication during pregnancy compared with children who were not exposed, using Cox proportional hazards regression analysis. Furthermore, we estimated the risk for autism spectrum disorder in a sibling design.
RESULTS:Children exposed prenatally to antidepressants had an adjusted hazard ratio of 1.5 (95% confidence interval [CI] 1.2-1.9) for autism spectrum disorder compared with unexposed children. Restricting the analysis to children of women with a diagnosis of affective disorder, the adjusted hazard ratio was 1.2 (95% CI 0.7-2.1), and the risk was further reduced when exposed children were compared with their unexposed siblings (adjusted hazard ratio 1.1; 95% CI 0.5-2.3).
CONCLUSION:After controlling for important confounding factors, there was no significant association between prenatal exposure to antidepressant medication and autism spectrum disorders in the offspring.

PMID: 24255601

Treatment of comorbid anxiety and autism spectrum disorders

Traduction: G.M.

Neuropsychiatry (London). 2011 Dec;1(6):567-578.

Traitement de l'anxiété concomitante et troubles du spectre autistique 

Nadeau J, Sulkowski ML, Ung D, Wood JJ, Lewin AB, Murphy TK, May JE, Storch EA.

Source

Department of Psychological & Social Foundations, University of South Florida, USA.

Abstract

L'anxiété cliniquement significative survient fréquemment chez les personnes avec des troubles du spectre autistique (TSA ) et est liée à l'augmentation des déficiences psychosociales , familiales , comportementales et académiques au-delà des principaux symptômes de l'autisme quand ils sont présents . 

Bien que des efforts sont en cours pour établir les traitements soutenus empiriquement pour l'anxiété chez les personnes avec TSA , cela reste un domaine de recherche émergent. 

Cette revue de la littérature résume les informations disponibles sur l'efficacité des approches pharmacologiques et psychosociales pour traiter l'anxiété et des comportements répétitifs chez les enfants, les adolescents et les adultes avec TSA . 

Plus précisément , nous évaluons la preuve de l' utilisation de la thérapie cognitivo-comportementale et inhibiteurs sélectifs du recaptage de la sérotonine . 

Les preuves s'accumulent en faveur de l'utilisation de la thérapie cognitivo -comportementale pour traiter l'anxiété chez les jeunes avec TSA , mais il existe des données contradictoires sur son application dans le traitement des comportements répétitifs , ainsi que l'utilisation des inhibiteurs sélectifs de la recapture de la sérotonine pour l'anxiété chez les jeunes avec  de TSA . 

Nous concluons cet article par une discussion sur la force de l'information actuelle et les prochaines étapes dans la recherche.

Clinically significant anxiety occurs frequently among individuals with autism spectrum disorders (ASDs) and is linked to increased psychosocial, familial, behavioral and academic impairment beyond the core autism symptoms when present. Although efforts are underway to establish empirically supported treatments for anxiety among individuals with ASDs, this remains an emerging research area. This literature review summarizes available information on the efficacy of pharmacological and psychosocial approaches for treating anxiety and repetitive behaviors in children, adolescents and adults with ASDs. Specifically, we evaluate evidence for the use of cognitive-behavioral therapy and selective serotonin-reuptake inhibitors. Evidence is growing in support of using cognitive-behavioral therapy to treat anxiety in youths with ASDs; however, mixed evidence exists for its application in treating repetitive behaviors, as well as the use of selective serotonin-reuptake inhibitors for anxiety in youths with ASDs. We conclude the article with a discussion of the strength of current information and next steps in research.

PMID:

 

24174992