背景:妊娠期苯二氮卓(BDZP)和/或z-催眠药配药在全球范围内有所增加,自闭症谱系障碍(ASD)和注意力缺陷多动障碍(ADHD)的发病率也是如此。本系统评价和荟萃分析旨在评估妊娠期暴露于BDZP和/或z-催眠药与后代ASD或ADHD诊断之间的关系。
方法:我们搜索了MEDLINE,EMBASE,和SCOPUS从成立到2023年12月,用于相关的英语文章。感兴趣的结果是ASD和ADHD的风险,两个独立的主要结果,在怀孕期间随时暴露于BDZP和/或z-催眠药的儿童中,与未暴露的儿童相比。次要结果是三个月分析。使用随机效应模型,我们汇总了总体和三个月的风险比(HRs),95%置信区间(CI),分别用于ASD和ADHD的风险。
结果:我们发现了6项符合条件的回顾性队列研究,没有病例对照研究。与任何时候妊娠BDZP和/或z-催眠暴露相关的ASD风险没有增加(主要结局,HR,1.10;95%CI,0.81-1.50;4项研究;n=3,783,417;80,270暴露,3,703,147未暴露)或妊娠早期暴露后(HR,1.15;95%CI,0.83-1.58;3项研究;n=1,539,335;70,737暴露,1,468,598未暴露)或妊娠后期暴露。在妊娠期任何时间接触这些药物(主要结果,HR,1.07;95%CI,1.03-1.12;4项研究;n=2,000,777;78,912暴露,1,921,865未暴露),也有(仅)孕中期暴露(HR,1.07;95%CI,1.03-1.12;3项研究;n=1,539,281;33,355暴露,1,505,926未暴露)。敏感性分析结果一致。
结论:妊娠暴露于苯二氮卓类药物或Z-催眠药与ASD风险增加无关,仅与后代ADHD风险增加有关。考虑到原始研究中适应症和未测量变量混淆的可能性,我们的研究结果应该让需要这些药物治疗的女性在怀孕期间出现严重焦虑或失眠。
BACKGROUND: Benzodiazepine (BDZP) and/or z-hypnotic dispensing during pregnancy has increased globally, as have rates of autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). This systematic
review and meta-analysis aimed to estimate the association between gestational exposure to BDZP and/or z-hypnotics and diagnosis of ASD or ADHD in offspring.
METHODS: We searched MEDLINE, EMBASE, and SCOPUS from inception till December 2023 for relevant English-language articles. Outcomes of interest were risk of ASD and ADHD, two independent primary outcomes, in children exposed anytime during pregnancy to BDZP and/or z-hypnotics versus those unexposed. Secondary outcomes were trimester-wise analyses. Using a random effects model, we pooled the overall and trimester-wise hazard ratios (HRs), with 95% confidence intervals (CIs), separately for risk of ASD and ADHD.
RESULTS: We found six eligible retrospective cohort studies and no case-control studies. There was no increased risk of ASD associated with anytime gestational BDZP and/or z-hypnotic exposure (primary outcome, HR, 1.10; 95% CI, 0.81-1.50; 4 studies; n = 3,783,417; 80,270 exposed, 3,703,147 unexposed) nor after first trimester exposure (HR, 1.15; 95% CI, 0.83-1.58; 3 studies; n = 1,539,335; 70,737 exposed, 1,468,598 unexposed) or later trimester exposures. A very small but significantly increased risk of ADHD was noted with anytime gestational exposure to these drugs (primary outcome, HR, 1.07; 95% CI, 1.03-1.12; 4 studies; n = 2,000,777; 78,912 exposed, 1,921,865 unexposed) and also with (only) second trimester exposure (HR, 1.07; 95% CI, 1.03-1.12; 3 studies; n = 1,539,281; 33,355 exposed, 1,505,926 unexposed). Findings were consistent in sensitivity analyses.
CONCLUSIONS: Gestational exposure to benzodiazepines or z-hypnotics was not associated with an increased risk of ASD and with only a marginally increased risk of ADHD in offspring. Given the likelihood of confounding by indication and by unmeasured variables in the original studies, our findings should reassure women who need these medications for severe anxiety or insomnia during pregnancy.