Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data
Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data
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DOI：
10.1001/archpsyc.63.8.898
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发表时间：
2006-08-01
影响因子：
--
通讯作者：
Hertzman, Clyde
中科院分区：
文献类型：
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作者：
Oberlander, Tim F.;Warburton, William;Hertzman, Clyde
背景：产前暴露于选择性血清素再摄取抑制剂（SSRI）抗抑郁药和母亲抑郁症都会改变新生儿健康，区分每种影响的影响仍然具有挑战性。目的：确定ssri类药物和抑郁症暴露是否不同于单独暴露于母亲抑郁症。设计：利用人口健康数据，将新生儿出生结果记录与孕产妇健康记录和产前孕产妇处方SSRIs联系起来。背景：加拿大不列颠哥伦比亚省人口。参与者：母亲和她们的婴儿，代表39个月期间的所有活产婴儿（N = 119547）（1998-2001）。主要结果测量：抑郁症母亲的婴儿接受SSRIs （SE-D）治疗的结果与未接受药物治疗的母亲的婴儿（DE）和非暴露对照组的结果进行比较。为了控制母亲精神疾病的严重程度，我们采用倾向评分匹配的方法来确定在怀孕前一年和怀孕期间与SE-D母亲特征相似的DE母亲的对照组。结果：14%的母亲在怀孕期间被诊断为抑郁症，在39个月的时间里，产前SSRI暴露的发生率从2.3%增加到5.0%。SE-D婴儿的出生体重和胎龄明显低于DE婴儿，少于37周出生的婴儿比例也明显低于DE婴儿（95%可信区间[CI]， -1至-64，-0.25至-0.45,-0.009至-0.04），尽管出生体重低于胎龄第10百分位的发生率差异不显著。与DE婴儿相比，SE-D婴儿出现新生儿呼吸窘迫（13.9% vs 7.8%）、黄疸（9.4% vs 7.5%）和喂养问题（3.9% vs 2.4%）的比例增加（95% CI分别为0.042-0.079、0.003-0.334和0.005-0.025）。当将SE-D与倾向评分匹配的DE新生儿的结果进行比较时，SE-D与出生体重低于第10百分位的发生率增加和呼吸窘迫发生率增加有关。结论：通过相关的人口健康数据和倾向评分匹配，产前SE-D暴露与低出生体重和呼吸窘迫的风险增加相关，即使考虑到母亲疾病的严重程度。
Context: Prenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants and maternal depression both alter neonatal health, and distinguishing the effects of each influence remains challenging.Objective: To determine whether exposure to SSRIs and depression differs from exposure to maternal depression alone.Design: Using population health data, records of neonatal birth outcomes were linked to records of maternal health and prenatal maternal prescriptions for SSRIs.Setting: Population of British Columbia, Canada.Participants: Mothers and their infants, representing all live births during a 39-month period (N = 119 547) (1998-2001).Main Outcome Measures: Outcomes from infants of depressed mothers treated with SSRIs (SE-D) were compared with outcomes from infants of depressed mothers not treated with medication (DE) and nonexposed controls. To control for maternal mental illness severity, propensity score matching was used to identify a comparison group of DE mothers who were similar to the SE-D mothers in characteristics in the year preceding and during pregnancy.Results: Fourteen percent of mothers were diagnosed as having depression during their pregnancy, and the incidence of prenatal SSRI exposure increased from 2.3% to 5.0% during a 39-month period. Birth weight and gestational age for SE-D infants were significantly less than for DE infants, as was the proportion of infants born at less than 37 weeks (95% confidence interval [CI], -1 to -64, -0.25 to -0.45, and -0.009 to -0.04, respectively), although differences in the incidence of birth weight less than the 10th percentile for gestational age were not significant. An increased proportion of SE-D infants had neonatal respiratory distress (13.9% vs 7.8%), jaundice (9.4% vs 7.5%), and feeding problems (3.9% vs 2.4%) compared with DE infants (95% CI of difference, 0.042-0.079, 0.003-0.334, and 0.005-0.025, respectively). When outcomes were compared between SE-D and propensity score-matched DE neonates, SE-D was associated with increased incidence of birth weight below the 10th percentile and rates of respiratory distress.Conclusion: With linked population health data and propensity score matching, prenatal SE-D exposure was associated with an increased risk of low birth weight and respiratory distress, even when maternal illness severity was accounted for.