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. 2019 Jul 11;14(7):e0219778.
doi: 10.1371/journal.pone.0219778. eCollection 2019.

Use and validity of child neurodevelopment outcome measures in studies on prenatal exposure to psychotropic and analgesic medications - A systematic review

Sarah Hjorth  1 , Rebecca Bromley  2   3 , Eivind Ystrom  1   4   5 , Angela Lupattelli  1 , Olav Spigset  6   7 , Hedvig Nordeng  1   8
Affiliations

Use and validity of child neurodevelopment outcome measures in studies on prenatal exposure to psychotropic and analgesic medications - A systematic review

Sarah Hjorth et al. PLoS One. .

Abstract

In recent years there has been increased attention to child neurodevelopment in studies on medication safety in pregnancy. Neurodevelopment is a multifactorial outcome that can be assessed by various assessors, using different measures. This has given rise to a debate on the validity of various measures of neurodevelopment. The aim of this review was twofold. Firstly we aimed to give an overview of studies on child neurodevelopment after prenatal exposure to central nervous system acting medications using psychotropics and analgesics as examples, giving special focus on the use and validity of outcome measures. Secondly, we aimed to give guidance on how to conduct and interpret medication safety studies with neurodevelopment outcomes. We conducted a systematic review in the MEDLINE, Embase, PsycINFO, Web of Science, Scopus, and Cochrane databases from inception to April 2019, including controlled studies on prenatal exposure to psychotropics or analgesics and child neurodevelopment, measured with standardised psychometric instruments or by diagnosis of neurodevelopmental disorder. The review management tool Covidence was used for data-extraction. Outcomes were grouped as motor skills, cognition, behaviour, emotionality, or "other". We identified 110 eligible papers (psychotropics, 82 papers, analgesics, 29 papers). A variety of neurodevelopmental outcome measures were used, including 27 different psychometric instruments administered by health care professionals, 15 different instruments completed by parents, and 13 different diagnostic categories. In 23 papers, no comments were made on the validity of the outcome measure. In conclusion, establishing neurodevelopmental safety includes assessing a wide variety of outcomes important for the child's daily functioning including motor skills, cognition, behaviour, and emotionality, with valid and reliable measures from infancy through to adolescence. Consensus is needed in the scientific community on how neurodevelopment should be assessed in medication safety in pregnancy studies. Review registration number: CRD42018086101 in the PROSPERO database.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flowchart.
WOS: Web of Science.
Fig 2
Fig 2. Domains of neurodevelopment evaluated and data sources used in medication safety papers on psychotropics.
Some papers had outcomes from more than one domain and assessments from more than one type of assessor. HCP: Health care professionals.
Fig 3
Fig 3. Domains of neurodevelopment evaluated and data sources used in medication safety papers on analgesics.
Some papers had outcomes from more than one domain and assessments from more than one type of assessor. HCP: Health care professionals.
Fig 4
Fig 4. Psychometric properties of the neurodevelopment outcome measure mentioned in medication safety papers on psychotropics and analgesics.
*Some papers commented on both validity and reliability, and those papers that commented on specific types of validity or reliability could comment on more than on type. One study used both diagnoses and psychometric instruments. Therefore the numbers add up to more than the total number of papers.
See this image and copyright information in PMC

References

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