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孕期应慎用对乙酰氨基酚!

2016-08-22 协和伟哥 医学界儿科频道

多数非处方药物通常认为妊娠期可安全使用,然而有些药物在孕期使用可能不利于胎儿发育。对乙酰氨基酚是最常用的解热镇痛药物,据调查,大约一半的孕期妇女曾使用过该药。然而,最近有研究认为,对乙酰氨基酚具有内分泌干扰作用,而孕期暴露内分泌干扰剂可能影响胎儿的神经系统发育,引起儿童期行为异常。因此,孕期须慎用对乙酰氨基酚!增加儿童多动症风险注意力缺陷/多动障碍(ADHD)是目前最常见的神经行为学异常性疾病,主

多数非处方药物通常认为妊娠期可安全使用,然而有些药物在孕期使用可能不利于胎儿发育。对乙酰氨基酚是最常用的解热镇痛药物,据调查,大约一半的孕期妇女曾使用过该药。然而,最近有研究认为,对乙酰氨基酚具有内分泌干扰作用,而孕期暴露内分泌干扰剂可能影响胎儿的神经系统发育,引起儿童期行为异常。因此,孕期须慎用对乙酰氨基酚!


增加儿童多动症风险


注意力缺陷/多动障碍(ADHD)是目前最常见的神经行为学异常性疾病,主要以注意力缺陷、多动、易冲动、动机/情感失调为特征。该病被认为由遗传和环境因素双重影响所致。一项纳入64322名儿童的大样本队列研究显示,母亲在妊娠期间服用对乙酰氨基酚,明显增加了儿童ADHD的发生风险。


该项研究根据在1996-2002年的出生队列,发现纳入人群中有一半的母亲曾在孕期服用对乙酰氨基酚,孕期使用该药的母亲,其后代在7岁左右被发现存在多动症、须ADHD治疗的患儿明显增加。进一步分析显示,尤其是在怀孕的中、晚期,以及在孕期用药频率越高时,其子代发生ADHD的风险越高。


由于孕期感染或免疫因素也曾被证实与儿童ADHD有关,对乙酰氨基酚常被用来缓解感染性疾病引起的症状,因此,可能会干扰该研究结果。在校正母亲本身的炎性疾病、孕期感染、母亲健康状况等混杂因素后,这种ADHD的风险相关性依然显著存在。


易导致多种行为异常


对乙酰氨基酚是最常用的解热镇痛药,一般认为在孕期可以安全使用,是妊娠期妇女解热镇痛药的一线选择。不过动物实验发现,孕期使用对乙酰氨基酚,特别是在妊娠的晚期,可影响子代的大脑认知功能和干扰脑源性神经营养因子的产生,其机制可能是由于对乙酰氨基酚的内分泌干扰作用。


考虑到妊娠晚期是大脑发育的活跃时期,该期的脑神经对药物的毒性作用更加敏感,妊娠晚期使用对乙酰氨基酚更容易引起儿童多种情感障碍和行为异常。最近发表在美国医学会儿科学杂志(JAMA Pediatrics)上的一项研究证实,产前对乙酰氨基酚暴露显著增加了儿童多种行为异常的发生风险,尤其是在妊娠晚期使用该药。


如何解释潜在的原因


在胎儿期,母亲的性激素和甲状腺激素对胎儿的大脑发育起着至关重要的作用。作为一种内分泌干扰剂,对乙酰氨基酚能够穿过胎盘屏障,妊娠期使用该药可能影响了这些关键激素的分泌,从而干扰了胎儿期的神经系统发育。有研究显示,孕期服用对乙酰氨基酚可增加男性儿童隐睾的发生风险。


此外,也有研究认为,长期使用对乙酰氨基酚能够降低血清中的抗氧化剂含量,破坏机体氧化剂与抗氧化剂的生理平衡,胎儿体内氧化剂含量的增加通过诱导氧化应激产生神经毒性,从而导致神经元死亡。


妊娠期慎用对乙酰氨基酚


总之,大样本的研究已经证实,孕期使用对乙酰氨基酚能够造成儿童神经行为发育的不良后果,在孕期应谨慎选择该药进行解热镇痛治疗,尤其是在胎儿神经系统发育的关键时期(妊娠中晚期)。另外,在必须使用解热镇痛药物时,应严格按照推荐剂量服用,或者可以考虑其他药物替代。


参考文献:

(1)Stergiakouli E, et al. Association of Acetaminophen Use During Pregnancy With Behavioral Problems in Childhood: Evidence Against Confounding. JAMA Pediatr. 2016 Aug 15.

(2)Liew Z, et al. Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatr. 2014 Apr;168(4):313-20.

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    2016-08-24 1dd8c52fm63(暂无匿称)

    必须学系!

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1952051, encodeId=a923195205137, content=<a href='/topic/show?id=3dbb2346632' target=_blank style='color:#2F92EE;'>#乙酰氨基酚#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23466, encryptionId=3dbb2346632, topicName=乙酰氨基酚)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac1c235, createdName=tonychen21, createdTime=Sat May 13 07:28:00 CST 2017, time=2017-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1321776, encodeId=21791321e760e, content=<a href='/topic/show?id=818246618a4' target=_blank style='color:#2F92EE;'>#对乙酰氨基酚#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46618, encryptionId=818246618a4, topicName=对乙酰氨基酚)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=afdf491, createdName=lilili1104, createdTime=Wed Aug 24 13:28:00 CST 2016, time=2016-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=102809, encodeId=965b1028096e, content=必须学系!, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Wed Aug 24 08:16:00 CST 2016, time=2016-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=102581, encodeId=216e102581cf, content=好好学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Tue Aug 23 16:45:00 CST 2016, time=2016-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=102538, encodeId=91da10253883, content=学习起来, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151005/IMG5612955936CFA7964.jpg, createdBy=18621654109, createdName=Guoxj3234, createdTime=Tue Aug 23 13:11:00 CST 2016, time=2016-08-23, status=1, ipAttribution=)]
    2016-08-23 忠诚向上

    好好学习一下

    0

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    2016-08-23 Guoxj3234

    学习起来

    0

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