治療哮喘的藥和早產可能增加發育中的胎兒患自閉癥的風險

Treatments For Asthma And Pre-Term Labor May Increase Risk Of Autism Spectrum Disorders In The Developing Fetus

03 Dec 2009  

Commonly prescribed beta 2 adrenergic agonist drugs for the treatment of asthma in pregnant women as well as pre-term labor may increase the incidence of autism-spectrum disorders, psychiatric pathology, cognitive problems and poor school performance in their children, according to a new study published in the December 2009 issue of the American Journal of Obstetrics & Gynecology.

通常給孕婦治療哮喘的藥物（β2腎上腺素受體激動劑）以及早產都可能會增加自閉癥和精神疾病的發病率，以及認知問題和學習成績較差。一項在2009年12月美國婦產科雜志上的研究發表。

Beta 2 adrenergic agonist drugs as a class are widely used in obstetrics as tocolytics to inhibit or slow down labor and bronchodilators, but may act as functional and behavioral teratogens when given continuously in the mid to late second or early third trimesters. By correlating the basic science and clinical data, investigators observed that when given prenatally, these drugs can cause functional and behavioral disorders by permanently altering the balance of sympathetic and parasympathetic tone in the individual. Animal studies support the concept that in humans prenatal exposure to continuous high doses of beta 2 adrenergic agonists can permanently dysregulate signaling from the beta 2 adrenergic receptor.

β2腎上腺素受體激動劑，這類藥物被產科廣泛用于抑制早產和支氣管擴張，但如果在懷孕第二期的中段到晚段，以及第三期的早段給予的話，會對胎兒生理造成缺陷。把相關的科學基礎和臨床數據進行關聯，研究人員觀察到,如果在產前吃了這些藥，可能會永久改變個人交感神經和副交感神經的平衡，從而導致功能和行為的失常。

Animal studies support the concept that in humans prenatal exposure to continuous high doses of beta 2 adrenergic agonists can permanently dysregulate signaling from the beta 2 adrenergic receptor.動物研究支持這一觀點，就是如果孕婦產前長期接受高劑量的β2受體激動劑會永久影響β2腎上腺素受體的信號傳導。

Researchers show how sympathetic overactivity and disease are correlated, citing studies that show the association between in utero exposure to beta 2 adrenergic agonists in humans and later development of these conditions.

研究人員展示了交感神經過度活躍和疾病相關，這個研究參考的文獻也支持了，在子宮內β2受體激動劑和后來發展的結果。

The authors also offer recommendations for safe practice in obstetrics in light of the teratogenic risk posed by beta 2 adrenergic agonists.

作者還提供如何安全使用β2腎上腺素受體激動劑能減低對胎兒造成的生理缺陷。

Writing in the article, Frank R. Witter, MD, , Johns Hopkins University School of Medicine and Johns Hopkins University Bloomberg School of Public Health, and co-authors state, "Given the risk of long-term neurophysiologic and behavioral impairment, the use of beta 2 adrenergic agonists should be limited to proven indications when alternate drugs are ineffective or unavailable and the risks of the untreated disease to the mother and fetus are greater than the risk of the beta 2 adrenergic agonist. Treatment duration should be as short as clinically feasible. Further ongoing surveillance of the use of these agents in pregnancy is needed to refine the parameters for their safe use in pregnancy. Future pharmacogenetics research is also needed to better characterize the highest risk group for teratogenesis from these agents.

"負責研究的弗蘭克惠博士（約翰霍普金斯大學醫學院和約翰霍普金斯大學彭博公共衛生學院），以及協同的研究人員說到：“考慮到長期的神經生理和行為障礙的風險，使用β2受體激動劑應僅限于其他被選藥物無效或不可用時，同時如果不治療這個疾病對母親和胎兒的風險要大于使用β2腎上腺素受體激動劑的風險。治療時間應盡可能短。關于孕期使用這類藥的安全參數需要進一步的研究和監督。今后的藥理學研究也需要更好地對藥物中會導致胎兒生理畸形的成分進行定性。

Echoing the concerns, Roberto Romero, MD, Chief, Perinatology Research Branch, Program Director for Obstetrics and Perinatology, Intramural Division, NICHD, NIH, DHHS and Associate Editor of the American Journal of Obstetrics & Gynecology, states that "The observations reviewed by the authors call for a re-examination of the commonly accepted safety of these agents during pregnancy." “Echoing the concerns, Roberto Romero, MD, Chief, Perinatology Research Branch, Program Director for Obstetrics and Perinatology, Intramural Division, NICHD, NIH, DHHS and Associate Editor of the American Journal of Obstetrics & Gynecology, states that "The observations reviewed by the authors call for a re-examination of the commonly accepted safety of these agents during pregnancy."

羅伯托羅梅羅（醫學博士，Chief, Perinatology Research Branch, Program Director for Obstetrics and Perinatology, Intramural Division, NICHD, NIH, DHHS and Associate Editor of the American Journal of Obstetrics & Gynecology）也指出：“通過研究者的觀察，需要我們對普遍認為孕期使用安全的藥物進行重新檢測?！?/SPAN>

Source: Elsevier

消息來源：Elsevier 翻譯：張苗苗