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.

通常给孕妇治疗哮喘的药物（β2肾上腺素受体激动剂）以及早产都可能会增加自闭症和精神疾病的发病率，以及认知问题和学习成绩较差。一项在2009年12月美国妇产科杂志上的研究发表。

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肾上腺素受体激动剂，这类药物被产科广泛用于抑制早产和支气管扩张，但如果在怀孕第二期的中段到晚段，以及第三期的早段给予的话，会对胎儿生理造成缺陷。把相关的科学基础和临床数据进行关联，研究人员观察到,如果在产前吃了这些药，可能会永久改变个人交感神经和副交感神经的平衡，从而导致功能和行为的失常。

Animal studies support the conce[NextPage]pt that in humans prenatal exposure to continuous high doses of beta 2 adrenergic agonists can permanently dysregulate signaling from the beta 2 adrenergic receptor.动物研究支持这一观点，就是如果孕妇产前长期接受高剂量的β2受体激动剂会永久影响β2肾上腺素受体的信号传导。

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.

研究人员展示了交感神经过度活跃和疾病相关，这个研究参考的文献也支持了，在子宫内β2受体激动剂和后来发展的结果。

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

作者还提供如何安全使用β2肾上腺素受体激动剂能减低对胎儿造成的生理缺陷。

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 t[NextPage]hese agents.

"负责研究的弗兰克惠博士（约翰霍普金斯大学医学院和约翰霍普金斯大学彭博公共卫生学院），以及协同的研究人员说到：“考虑到长期的神经生理和行为障碍的风险，使用β2受体激动剂应仅限于其他被选药物无效或不可用时，同时如果不治疗这个疾病对母亲和胎儿的风险要大于使用β2肾上腺素受体激动剂的风险。治疗时间应尽可能短。关于孕期使用这类药的安全参数需要进一步的研究和监督。今后的药理学研究也需要更好地对药物中会导致胎儿生理畸形的成分进行定性。

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."

罗伯托罗梅罗（医学博士，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：“通过研究者的观察，需要我们对普遍认为孕期使用安全的药物进行重新检测。”

Source: Elsevier

消息来源：Elsevier 翻译：张苗苗