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孕期接受类固醇激素治疗增加儿童精神和行为障碍的风险
作者:小柯机器人 发布时间:2020/5/20 21:10:22

近日,芬兰卫生福利研究所Eero Kajantie联合赫尔辛基大学Katri Räikkönen团队分析了孕妇产前接受皮质类固醇治疗与儿童精神和行为障碍的相关性。该成果发表在2020年5月19日出版的《美国医学会杂志》上。

当胎儿在34周前即将分娩时,孕期激素治疗是加速胎儿成熟的标准方案。最近,将其适应症扩展到超过孕34周存在争议。但长期结局的数据仍然有限,特别是接受治疗后足月出生的婴儿。

为了探讨产前皮质类固醇治疗是否与足月儿(≥37周)和早产儿(<37周)的精神和行为障碍有关,研究组对芬兰2006年1月1日至2017年12月31日出生登记且存活1年以上的单胎活产婴儿进行了一项基于人群的回顾性队列研究。

共有670097名单胎婴儿符合分析条件。中位随访5.8年后,在母亲孕期接受皮质类固醇治疗的14868名婴儿(2.22%,女婴占46.1%)中,足月儿6730例(45.27%),早产儿8138例(54.74%);在655229例(97.78%,女婴48.9%)母亲孕期未接受皮质类固醇治疗的婴儿中,足月儿634757例(96.88%),早产儿20472例(3.12%)。

在241621对符合条件的足月儿同胞配对中,有4128对(1.71%)对孕期激素治疗不满意。孕期激素治疗的儿童队列中发生任何精神和行为障碍的风险为12.01%,显著高于未治疗儿童队列(6.45%),两组间足月儿发病风险分别为8.89%与6.31%,差异亦显著。

孕期接受激素治疗的儿童和未接受治疗的兄弟姐妹发生任何精神和行为障碍的风险分别为6.56%和4.17%。在早产儿中,孕期激素治疗儿童的心理和行为障碍累积发生率为14.59%,显著高于未接受治疗的儿童(10.71%),但HR不显著。

综上,母亲产前接受皮质类固醇激素治疗与儿童精神和行为障碍显著相关。

附:英文原文

Title: Associations Between Maternal Antenatal Corticosteroid Treatment and Mental and Behavioral Disorders in Children

Author: Katri Rikknen, Mika Gissler, Eero Kajantie

Issue&Volume: 2020/05/19

Abstract: Importance  Maternal antenatal corticosteroid treatment is standard care to accelerate fetal maturation when birth before 34 weeks is imminent. Recently, expansion of the indications beyond 34 gestational weeks has been debated. However, data about long-term outcomes remain limited, especially among infants who after treatment exposure are born at term.

Objective  To study if antenatal corticosteroid treatment is associated with mental and behavioral disorders in children born at term (≥37 weeks 0 days’ gestation) and preterm (<37 weeks 0 days’ gestation) and if unmeasured familial confounding explains these associations.

Design, Setting, and Participants  Population-based retrospective cohort study using nationwide registries of all singleton live births in Finland surviving until 1 year and a within-sibpair comparison among term siblings. Children were born between January 1, 2006, and December 31, 2017, and followed up until December 31, 2017.

Exposures  Maternal antenatal corticosteroid treatment.

Main Outcomes and Measures  Primary outcome was any childhood mental and behavioral disorder diagnosed in public specialized medical care settings.

Results  Of the 674877 singleton children born in Finland during the study period, 670097 were eligible for analysis. The median length of follow-up was 5.8 (interquartile-range, 3.1-8.7) years. Of the 14868 (2.22%; 46.1% female) corticosteroid treatment–exposed children, 6730 (45.27%) were born at term and 8138 (54.74%) were born preterm; of the 655229 (97.78%; 48.9% female) nonexposed children, 634757 (96.88%) were born at term and 20472 (3.12%) were born preterm. Among the 241621 eligible term-born maternal sibpairs nested within this population, 4128 (1.71%) pairs were discordant for treatment exposure. Treatment exposure, compared with nonexposure, was significantly associated with higher risk of any mental and behavioral disorder in the entire cohort of children (12.01% vs 6.45%; absolute difference, 5.56% [95% CI, 5.04%-6.19%]; adjusted hazard ratio [HR], 1.33 [95% CI, 1.26-1.41]), in term-born children (8.89% vs 6.31%; absolute difference, 2.58% [95% CI, 1.92%-3.29%]; HR, 1.47 [95% CI, 1.36-1.69]), and when sibpairs discordant for treatment exposure were compared with sibpairs concordant for nonexposure (6.56% vs 4.17% for within-sibpair differences; absolute difference, 2.40% [95% CI, 1.67%-3.21%]; HR, 1.38 [95% CI, 1.21-1.58]). In preterm-born children, the cumulative incidence rate of any mental and behavioral disorder was also significantly higher for the treatment-exposed compared with the nonexposed children, but the HR was not significant (14.59% vs 10.71%; absolute difference, 3.38% [95% CI, 2.95%-4.87%]; HR, 1.00 [95% CI, 0.92-1.09]).

Conclusions and Relevance  In this population-based cohort study, exposure to maternal antenatal corticosteroid treatment was significantly associated with mental and behavioral disorders in children. These findings may help inform decisions about maternal antenatal corticosteroid treatment.

DOI: 10.1001/jama.2020.3937

Source: https://jamanetwork.com/journals/jama/article-abstract/2766162

期刊信息

JAMA-Journal of The American Medical Association:《美国医学会杂志》,创刊于1883年。隶属于美国医学协会,最新IF:51.273
官方网址:https://jamanetwork.com/
投稿链接:http://manuscripts.jama.com/cgi-bin/main.plex