科学如何看待泰诺与自闭症的关系

欢迎收听《呼叫古普塔医生》。

Welcome to Paging Dr Gupta.

这个节目让我有机会听到你们的声音，也希望我能为你们的问题提供一些有用的答案。

This is the show where I get to hear from you and hopefully provide you with some answers to your questions that are useful.

在今天的节目中，我们要讨论一个你们肯定已经读到或听说过的内容。

On today's episode, we're gonna address something that you've surely read or heard about by now.

首先，立即生效，FDA将通知医生，关于对乙酰氨基酚的使用。

First, effective immediately, the FDA will be notifying physicians that the use of Acetaminophen.

对乙酰氨基酚。

Acetaminophen.

这样可以吗？

Is that okay?

是的。

Yes.

是的。

Yes.

其实就是大家常说的泰诺。

Which is basically commonly known as Tylenol.

那当然是特朗普总统说的，他提到美国食品药品监督管理局对孕妇使用对乙酰氨基酚，也就是泰诺，发布了新的警告。

That, of course, was president Trump, and he was talking about a new warning by the US Food and Drug Administration over the use of acetaminophen, Tylenol, by pregnant women.

那现在该怎么办呢？

Now, what to do?

这之间有什么联系？

What is the link?

这种联系有多强？

How strong is it?

接下来人们应该怎么做？

And what should people do moving forward?

广告之后，我们来看看大家关于这个话题的一些问题。

Let's get into a couple of your questions on the topic right after this break.

这周收到了很多问题，但我想先从一些基本的问题开始。

Now there's a lot of questions that came in this week, but I wanted to start off with some basics.

对乙酰氨基酚，在欧洲主要称为扑热息痛，以泰诺这个品牌名销售。

Acetaminophen, also called paracetamol primarily in Europe, is sold under the brand name Tylenol.

你现在可能药柜里就有一些。

You probably have some of it in your medicine cabinet right now.

需要注意的是，对乙酰氨基酚被认为是孕妇唯一安全的非处方止痛或退烧选择。

Now it's important to note that acetaminophen is considered the only safe over the counter option for pain or fever for a pregnant woman.

至于阿司匹林、布洛芬或消炎药，它们对胎儿有已知的风险。

When it comes to things like aspirin or ibuprofen or anti inflammatories, they carry known risks to the baby.

这就是为什么许多专业医生团体和公共卫生组织长期以来一直支持在怀孕期间使用泰诺，剂量尽可能低，时间尽可能短。

That is why many professional physician groups and public health organizations have long supported the use of Tylenol at the lowest dose possible for the shortest amount of time to be used during pregnancy.

重要的是，怀孕期间未处理的发烧可能会伤害发育中的胎儿。

And importantly, untreated fever during pregnancy can harm a growing fetus.

需要明确的是，FDA的警告并没有告诉女性停止服用对乙酰氨基酚，而是说她们应该，引用一下，考虑在怀孕期间尽量减少使用对乙酰氨基酚来应对常规的低烧。

Now to be clear, the FDA warning does not tell women to stop taking acetaminophen, but rather says they should, quote, consider minimizing the use of acetaminophen during pregnancy for routine low grade fevers.

再说一次，这已经是推荐做法有一段时间了。

Again, that has been the recommendations for some time now.

FDA还表示，没有证据表明对乙酰氨基酚和自闭症之间存在因果关系，也就是因果联系。

The FDA also said there is no evidence of a causal relationship, meaning a cause and effect relationship between acetaminophen and autism.

我想告诉你，我们报道泰诺和自闭症之间可能存在的关联已经有一段时间了。

Just want to tell you, we've been reporting on this potential association between Tylenol and autism for some time.

相关研究已经陆续发表了大约二十年。

Studies have been coming out for some twenty years now.

通常的情况是，你首先会得到一个信号，表明可能有什么事情发生。

And the way things often work is that you get a signal of something going on.

比如，我们发现那些说自己在怀孕期间服用过泰诺的女性，她们的孩子自闭症发病率更高。

Hey, we see increased rates of autism in women who say they took Tylenol during their pregnancy.

然后我们就开始更深入地调查。

Let's start to investigate that more.

那些初步的研究通常质量不高，因为你基本上是让一位女性，在多年后孩子可能被诊断出自闭症的情况下，去回忆她怀孕时是否服用过泰诺。

Those initial studies are typically not very good because you're essentially asking a woman who subsequently, years later, may have a child diagnosed with autism to try and remember, did they take Tylenol when they were pregnant?

如果服用过，是什么时候服用的？

If so, when did they take Tylenol?

他们吃了多少泰诺？

How much Tylenol did they take?

这确实很难记得。

It can be hard to remember.

这就是我要说的重点。

That's the point I'm making here.

这些研究真的很难做。

These studies are really hard to do.

还有其他研究，实际上检查了脐带血，测量脐带血来试图确定怀孕不同时期对乙酰氨基酚的暴露情况，同样，那里也发现了关联。

There are other studies that have been done that actually looked at cord blood, measured cord blood to try and figure out acetaminophen exposure at different times during pregnancy, and again, associations were seen there.

但关联就只是关联。

But associations are just that.

当你有像泰诺这样无处不在的东西时，你可以把它和几乎任何事情联系起来。

And when you have something that's as ubiquitous as Tylenol, you can associate it to just about anything.

正如一位研究研究人员所说，在炎热的天气里，暴力犯罪会增加。

As one of the study researchers said, in the hot weather, violent crime goes up.

天气热的时候，冰淇淋销量也会上升。

In hot weather, ice cream sales go up.

这两件事都发生在天气热的时候，但它们之间可能真的没什么关系，尽管可以被认为有关联。

Both those things are happening during hot weather, but they really probably have nothing to do with each other even though they could be considered associated.

这就是关键词。

That's the keyword.

这里说的是关联，不是因果关系。

Association here, not cause and effect.

不过我要说，去年瑞典发表了一项有趣的研究。

I will say there was an interesting study done out of Sweden published last year.

他们跟踪了1995年到2019年间出生的超过两百万名儿童。

They followed more than two million children born between 1995 and 2019.

其中大约有十八万五千名儿童的母亲在怀孕期间使用了醋氨酚。

About one hundred and eighty five thousand of them were born to mothers who used acetaminophen during pregnancy.

然后他们能够比较这些儿童的自闭症发生率，与他们的兄弟姐妹以及未接触过该药物的儿童进行比较，基本上建立了一个遗传对照组。

They were then able to compare autism rates of these children with their siblings and with children who were not exposed, essentially creating a sort of genetic control group.

在那项研究中，他们没有发现使用对乙酰氨基酚会增加自闭症或其他神经发育障碍的风险。

And in that study, they found no associated increased risk of autism or other neurodevelopmental disorders in response to the use of acetaminophen.

所以你看，现在有各种各样的研究。

So look, there's all these various studies out there.

我们听总统说过。

We've heard from the president.

我们也听FDA局长提过这个可能的关联。

We've heard from the FDA commissioner about this potential association.

你也知道那些建议是什么。

You've heard what the recommendations are.

再说一次，这些建议和医生们一直以来的推荐其实没什么不同。

Again, really not different than what doctors have been recommending for some time.

在我回答你们的问题之前，我觉得有一点很重要，就是任何时候你考虑吃药，不管是处方药还是非处方药，都应该慎重。

And before I get into your questions, I think it is important to note that any time you think about taking a medication, whether it be a prescription medication or even an over the counter medication, you should be thoughtful about it.

我真的需要吃这个药吗？

Do I really need to take this medication?

还有其他选择吗？

Are there other options?

泰诺也是如此，尤其是在怀孕期间。

And the same can be said when it comes to Tylenol, especially during pregnancy.

孕妇容易感染，因为身体在怀孕期间会有一段时间免疫力下降，这样才能让胎儿顺利发育。

Pregnant women are at risk of infections because your body is essentially immune compromised for a period of time to help allow you to carry the baby.

这也是为什么女性更容易感染，感染会导致发烧，进而可能增加泰诺的使用。

That is part of the reason women are at higher risk for infections, which can lead to fevers, which may lead to increased use of Tylenol.

好的。

Okay.

凯拉回来了。

Keira is back with us.

第一个问题是什么？

What's the first question?

你好，桑杰。

Hi, Sanjay.

好的。

Okay.

我们收到了很多关于这个话题的电话和留言，其中有一个特别引人注目，来自温哥华的德文。

So we've been getting a lot of calls and messages about this topic, and one that really stood out came from Devon in Vancouver.

他们想知道，这场讨论是不是应该更聚焦于那些习惯经常服用泰诺的孕妇。

Now they're wondering if this whole conversation should have been more focused on pregnant women who are used to taking Tylenol pretty regularly.

桑杰，你怎么看？

So what do you think about that, Sanjay?

听着，我觉得这正是关键点，德文。

Look, I think this is the important point, Devin.

这里有个细微差别。

There is a nuance here.

我要指出的一点是，由于对泰诺与自闭症潜在关联的担忧，过去二十年里，我们看到的情况是，过去十年中，孕期泰诺的使用实际上有所下降，而自闭症发病率却在上升。

One thing I will point out is that because of the concerns about Tylenol and its potential association with autism, over the last twenty years now, what we have seen is that Tylenol use during pregnancy has actually gone down over the last decade, even as autism rates have gone up.

这一点你需要注意。

That's just something you should note.

泰诺使用量下降，自闭症发病率上升，这意味着什么？

Tylenol use going down, autism rates going up, what does that mean?

但我觉得你的观点是对的。

But I think your point is the right point.

在某些情况下，显然，泰诺是有益的。

In certain situations, obviously, Tylenol can be beneficial.

怀孕期间你不想发烧。

You do not want to have a fever when you are pregnant.

那可能会带来很多伤害。

There can be a lot of harm from that.

但同时，我们也不想过度使用泰诺。

And yet at the same time, we don't want to overdo the use of Tylenol.

让我再补充一些细节。

Let me layer a little bit more nuance to this.

挪威有一项研究发现，怀孕期间接触对乙酰氨基酚29天或更长时间，大约一个月，孩子被诊断出多动症的风险增加了一倍。

There was a study out in Norway that found that children who were exposed to acetaminophen during pregnancy for twenty nine or more days, so roughly a month, had an increased risk of ADHD diagnosis, a twofold increase in risk.

再说一遍，这只是一个关联性研究。

Again, this is an association study.

但他们还发现，怀孕期间服用泰诺一到七天的女性，宝宝出现这类问题的风险反而更低。

But what they also found was that women who took Tylenol for one to seven days during pregnancy actually saw a lowered risk of such problem in their babies.

所以，适当处理发烧似乎有保护作用，而服用过多泰诺，比如超过一个月，可能就有问题了。

So treating fevers appropriately seems to have been protective, whereas taking perhaps too much Tylenol, taking it for more than a month, may have been problematic.

所以短期使用对宝宝来说，比不处理发烧要好。

So short term use was better for the baby than leaving a fever untreated.

但如果服用泰诺达到一个月左右，可能就有潜在风险了。

But when you get to a month or so of Tylenol use, that may potentially be problematic.

再说一次，这只是关联。

Again, an association.

但你为什么要吃泰诺呢？

But why are you taking the Tylenol?

你为什么发烧？

Why do you have a fever?

如果发烧是由感染引起的，那背后的感染到底是什么？

What is the underlying infection if that's what's driving the fever?

要确保你从整体上处理这个问题。

Making sure you address this in totality.

休息之后，我们将具体探讨怀孕期间发烧可能带来的风险，以及如何将这些风险降到最低。

After the break, we're going look at the risks specifically that fevers can present during pregnancy, and what can be done to minimize them.

我是奥迪·科尼什。

I'm Audi Cornish.

我是阿里·夏皮罗，

I'm Ari Shapiro,

这是订婚派对。

and it's engagement party.

这是订婚派对。

It's engagement party.

我们可以聊聊我们痴迷什么，关注什么，需要和朋友一起消化什么。

Get to talk about what we're obsessed with, what we're engaged with, what we need to process with a friend.

现在流行文化里到处都是这个话题，我觉得我们绕了很久了，所以很高兴终于能做一期节目，就是戒酒和康复。

And one of the things that is everywhere in pop culture right now that I feel like we've been circling around for a while, so I'm glad we're finally doing an episode about it, is sobriety Recovery.

少喝点酒。

Drinking less.

这些都是相关且重叠的事情，声音越来越大，越来越大。

These are all related and overlapping things getting louder and louder and louder.

我们请来了一位嘉宾，AJ·德莱里奥。

And we're gonna have a guest, AJ Delerio.

他曾经是Gawker Media的超级编辑，但在他成瘾期间，这家公司轰然倒塌了。

He was a onetime super editor of Gawker Media, which all came tumbling down in the midst of his addiction.

对我来说，戒酒是一种彻底的心理转变，就像十二步法里说的那样。

Sobriety for me is a complete psychic change, as they call it in 12 step.

我得学会在生活的方方面面更好地对待自己，这比单纯戒酒要费劲得多。

I have to figure out how to treat myself better in all aspects of my life, and that takes a lot more work than just stopping drinking.

关注《订婚派对》。

Follow engagement party.

无论你在哪里收听播客。

Wherever you get your podcasts.

好的，欢迎回到《呼叫古普塔医生》。

Okay, welcome back to Paging Dr Gupta.

今天我们要讨论的是怀孕期间服用泰诺与自闭症风险的问题。

Today, we are talking about the use of Tylenol during pregnancy and the risk of autism.

凯拉，接下来我们请到的是谁？

Kira, who do we have next?

好的，我们还收到了来自新墨西哥州的梅根的来电，她提出了另一个非常重要的角度，想知道怀孕期间发烧对母亲和婴儿可能带来哪些风险。

Okay, and we also heard from Megan in New Mexico, and she brought up another really important angle and is curious about what risks a fever during pregnancy can pose both for the parent and the baby.

好的，卡拉，谢谢你，也谢谢梅根，因为我觉得这触及了这个问题最大的疑问之一。

Okay, Kara, thank you, and thank you, Megan, as well, because I think this gets to one of the biggest questions around the issue.

再次强调，需要指出的是，对乙酰氨基酚确实是孕妇退烧唯一安全的选择。

Again, it is important to point out that acetaminophen is really the only safe option for pregnant women to treat a fever.

有研究使用阿司匹林和非甾体抗炎药，比如布洛芬，但这些都带有明确的风险。

There have been studies using aspirin and nonsteroidal anti inflammatories, ibuprofen, and those all carry objective risks.

对乙酰氨基酚确实是安全的选择，尤其是在孕早期体温达到103度或更高的时候。

Acetaminophen is really the safe option, especially true if you have a temperature of 103 or higher in the first trimester.

为什么？

Why?

因为这么高的体温会增加大脑、脊柱和脊髓出生缺陷的风险。

Because a temperature that high can increase the risk of birth defects in the brain, the spine, and the spinal cord.

这些器官系统都在那个时期发育，如果身体不是正常体温，可能会影响这些系统的正常发育。

Those are all organ systems that are developing around that time, and if the body is not normothermic of a normal temperature, that could affect the way those body systems actually develop.

唇裂和腭裂也可能受到未处理发烧的影响。

Cleft lip, cleft palate, they can also be affected by untreated fever.

还有先天性心脏缺陷、早产和流产。

Congenital heart defects, early labor, and miscarriage.

在怀孕前或怀孕早期发烧的人，生出神经管缺陷孩子的可能性是没发烧的人的两倍多。

People who had a fever just before or during early pregnancy were more than twice as likely to have a child with a neural tube defect than those who didn't have a fever.

甚至有一些早期研究发现，发烧也会增加自闭症的风险。

And there have even been some early studies that have found increased risk of autism from fever.

这正是我们整个讨论要预防的核心问题。

The very thing that obviously this whole discussion is about in terms of what we're trying to prevent here.

记住，人体平均体温大约是98.6华氏度，而关于这个话题的很多研究，都是在孕妇体温达到103度时进行的。

Keep in mind, the average body temperature is around 98.6 degrees, and a lot of the studies on this topic have been done in women who are pregnant when their temperature reached a 103 degrees.

好的，卡拉，我们再来回答一个问题。

Okay, Kara, time for one more question.

最后一个问题，来自缅因州的比尔，他想知道孕妇可以采取哪些措施来降低发烧的风险。

So last up, have Bill in Maine who wants to know what steps someone could take to lower their chances of getting a fever while they're pregnant.

好的。

Alright.

要降低孕期发烧的风险，措施听起来会很基本。

The steps you can take to minimize the risk of fever while pregnant are going to sound pretty basic.

保持免疫系统健康，勤洗手，保证充足睡眠，及时接种疫苗。

Keep your immune system up, wash hands, make sure you're getting enough sleep, be up to date on your vaccinations.

再次提醒，女性在怀孕期间实际上免疫系统是有所削弱的。

Keep in mind again that women are essentially immune compromised during the time they are pregnant.

这有助于她们顺利地把宝宝怀到足月。

That helps allow them carry the baby successfully to pregnancy.

女性在怀孕期间发烧，最常见的原因包括耳朵感染、食物中毒、肠胃炎、尿路感染，当然还有像新冠和流感这样的呼吸道病毒。

Some of the most common reasons that women develop a fever while pregnant are ear infection, food poisoning, stomach virus, urinary tract infection, and of course, respiratory viruses like COVID and the flu.

所以，确保接种推荐的疫苗，并且在孕期好好照顾自己，避免接触潜在的病原体，这似乎能起到很大的作用。

So making sure you get recommended vaccines and really taking care of yourself during this time to not expose yourself to potential pathogens seems to make a huge difference.

如果真的发烧了，一定要跟医生沟通。

If you do have a fever, talk to your doctor.

医生很可能会建议你服用泰诺，也就是对乙酰氨基酚。

They may likely suggest taking Tylenol, taking acetaminophen.

再次强调，怀孕期间不要用阿司匹林或布洛芬来退烧。

Again, should not take aspirin or ibuprofen to lower your fever while pregnant.

不过，如果医生因为子痫前期等问题建议你服用低剂量阿司匹林，那是可以的。

It is okay to take low dose aspirin during pregnancy if your provider recommends it for something like preeclampsia.

但也有一些其他方法可以尝试，比如如果烧得不是很高，可以用降温毯。

But there's also other things you could potentially do, like using cooling blankets if the fever is not that high.

你看。

Look.

这个话题确实让人困惑，我觉得上周变得更让人困惑了。

It's a confusing topic, and I think it got a lot more confusing this past week.

希望今天的节目能帮大家澄清一些困惑，也感谢所有提问的听众。

I hope we were able to clear up some of that confusion with today's episode, and thanks to everyone who sent in questions.

我们收到了好多关于这个的问题。

We got so many questions on this.

我们想继续听到你们的声音。

We want to continue to hear from you.

如果你有健康方面的疑问，欢迎发给我们。

If there's something health related you've been wondering about, send it to us.

我们可能会在下周回答。

We might answer it next week.

录一段语音备忘录。

Record a voice memo.

发邮件到asksanjaycnn点com，或者给我们打电话，(470) 396-0832，留言就行。

Email it to asksanjaycnn dot com, or give us a call, (470) 396-0832, and leave a message.

感谢收听。

Thanks for listening.

下周二我还会回来。

I'll be back next Tuesday.

准备好迎接选举之夜吧。

Get ready for election night.

现在订阅全访问套餐，就可以在CNN上观看直播。

CNN is available to stream live now with an all access subscription.

另外，还能获得独家内容和与CNN记者互动的问答环节。

Plus, get exclusive content and interactive q and a's with CNN's journalists.

现在就订阅吧。

Subscribe now.

访问cnn.com/allaccess。

Visit cnn.com/allaccess.

这次选举的利害关系再大不过了。

The stakes couldn't be higher.

加入CNN可信赖的记者团队，一起关注美国大选之夜。

Join CNN's trusted journalists for election night in America.

报道将于11月3日五点开始在CNN播出，或者通过全访问订阅进行直播。

Coverage starts November 3 at five on CNN or streaming live with an all access subscription.

请访问cnn.com/allaccess订阅。

Subscribe at cnn.com/allaccess.