Lithium Use in Pregnancy and the Risk of Cardiac Malformations
Lithium Use in Pregnancy and the Risk of Cardiac Malformations
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怀孕期间使用锂和心脏畸形的风险
DOI：
10.1097/01.ogx.0000526705.23869.b5
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发表时间：
2017
影响因子：
6.2
通讯作者：
S. Hernández
中科院分区：
文献类型：
--
作者：
Elisabetta Patorno;K. Huybrechts;B. Bateman;J. Cohen;R. Desai;H. Mogun;L. Cohen;S. Hernández
研究背景：人们一直担心，妊娠早期暴露于锂可能与婴儿Ebstein异常（右心室流出道梗阻缺陷）和先天性心脏缺陷的风险显著增加有关，但相关数据相互矛盾且有限。方法：我们进行了一项队列研究，包括1325563名在2000年至2010年期间参加医疗补助计划并分娩一名活产婴儿的孕妇。我们检查了在妊娠早期暴露于锂的婴儿与未暴露于锂的婴儿的心脏畸形风险，并在二次分析中，与暴露于另一种常用的情绪稳定剂拉莫三嗪的婴儿进行了比较。在精神病和医疗状况、药物和其他潜在混杂因素的对照下，估计风险比和95%置信区间。结果663例锂暴露婴儿中有16例出现心脏畸形（2.41%），1,322,955例未暴露婴儿中有15,251例出现心脏畸形（1.15%），1945例拉莫三嗪暴露婴儿中有27例出现心脏畸形（1.39%）。与未接触锂的婴儿相比，接触锂的婴儿心脏畸形的调整风险比为1.65（95%可信区间[CI]， 1.02至2.68）。每日剂量为600毫克或以下的风险比为1.11 (95% CI， 0.46至2.64)，601至900毫克的风险比为1.60 (95% CI， 0.67至3.80)，超过900毫克的风险比为3.22 （95% CI， 1.47至7.02）。锂暴露的婴儿右心室流出道梗阻缺陷的发生率为0.60%，而未暴露的婴儿为0.18%（校正风险比为2.66；95% CI为1.00 - 7.06）。当暴露于拉莫三嗪的婴儿作为参照组时，结果相似。结论：产妇在妊娠早期使用锂与心脏畸形的风险增加相关，包括Ebstein异常；这种影响的程度比先前假设的要小。（由国家心理健康研究所资助。）
BACKGROUND There has been concern that exposure to lithium early in pregnancy may be associated with a marked increase in the risk of Ebstein's anomaly (a right ventricular outflow tract obstruction defect) in infants and overall congenital cardiac defects, but data are conflicting and limited. METHODS We conducted a cohort study involving 1,325,563 pregnancies in women who were enrolled in Medicaid and who delivered a live‐born infant between 2000 and 2010. We examined the risk of cardiac malformations among infants exposed to lithium during the first trimester as compared with unexposed infants and, in secondary analyses, with infants exposed to another commonly used mood stabilizer, lamotrigine. Risk ratios and 95% confidence intervals were estimated with control for psychiatric and medical conditions, medications, and other potential confounders. RESULTS Cardiac malformations were present in 16 of the 663 infants exposed to lithium (2.41%), 15,251 of the 1,322,955 nonexposed infants (1.15%), and 27 of the 1945 infants exposed to lamotrigine (1.39%). The adjusted risk ratio for cardiac malformations among infants exposed to lithium as compared with unexposed infants was 1.65 (95% confidence interval [CI], 1.02 to 2.68). The risk ratio was 1.11 (95% CI, 0.46 to 2.64) for a daily dose of 600 mg or less, 1.60 (95% CI, 0.67 to 3.80) for 601 to 900 mg, and 3.22 (95% CI, 1.47 to 7.02) for more than 900 mg. The prevalence of right ventricular outflow tract obstruction defects was 0.60% among lithium‐exposed infants versus 0.18% among unexposed infants (adjusted risk ratio, 2.66; 95% CI, 1.00 to 7.06). Results were similar when lamotrigine‐exposed infants were used as the reference group. CONCLUSIONS Maternal use of lithium during the first trimester was associated with an increased risk of cardiac malformations, including Ebstein's anomaly; the magnitude of this effect was smaller than had been previously postulated. (Funded by the National Institute of Mental Health.)
DOI：
10.1097/01.aoa.0000463845.01058.75
发表时间：
2014-06
期刊：
Obstetric Anesthesia Digest
影响因子：
--
作者：
K. Huybrechts;K. Palmsten;J. Avorn;L. Cohen;L. Holmes;J. Franklin;H. Mogun;R. Levin;Mary K. Kowal;S. Setoguchi;S. Hernández-Díaz
通讯作者：
K. Huybrechts;K. Palmsten;J. Avorn;L. Cohen;L. Holmes;J. Franklin;H. Mogun;R. Levin;Mary K. Kowal;S. Setoguchi;S. Hernández-Díaz