Associations between antidepressant use patterns during pregnancy and birth outcomes among periconception antidepressant users.
Associations between antidepressant use patterns during pregnancy and birth outcomes among periconception antidepressant users.
复制标题
妊娠期间抗抑郁药使用模式与围孕期抗抑郁药使用者的出生结果之间的关联。
DOI：
10.1002/phar.2790
复制
发表时间：
2023
期刊：
影响因子：
4.1
通讯作者：
Avalos,LyndsayA
中科院分区：
文献类型：
--
作者：
Nance,Nerissa;Badon,SylviaE;Ridout,Kathryn;Ahern,Jennifer;Li,De-Kun;Quesenberry,Charles;Avalos,LyndsayA
背景：人们对围孕期（怀孕前和怀孕后）服用者在怀孕期间使用抗抑郁药物的模式知之甚少。此外，在考虑到潜在的抑郁严重程度后，这些模式与出生结果之间的关系尚不清楚。目的：本研究描述了围孕期使用抗抑郁药的模式，并探讨了使用模式与出生结果之间的关系。这项回顾性队列研究包括2014年至2017年期间活产的孕妇凯撒医疗机构北加州（KPNC）成员，并在怀孕第8周服用抗抑郁药物。结果是早产和新生儿重症监护病房（NICU）入院。数据从KPNC的电子健康记录中提取。采用修正泊松回归。结果在符合纳入标准的3637例妊娠中，33% （n= 1204）在妊娠期间继续使用抗抑郁药（在妊娠期间补充），47% （n= 1721）停止使用抗抑郁药（未补充），20% （n= 712）停止并重新使用抗抑郁药（在供应间隔30天以上后补充）。与妊娠期间停用该药的妇女相比，继续使用该药的妇女早产风险为1.86（95%可信区间（CI） 1.53, 2.27）倍，入院新生儿重症监护病房风险为1.76 （95% CI: 1.42, 2.19）倍。同样，与停止使用并重新开始使用的妇女相比，继续使用的妇女早产风险为1.66 （95% CI: 1.27, 2.18）倍，进入新生儿重症监护病房的风险为1.85 （95% CI: 1.39, 2.46）倍。这种关系在检查持续暴露时成立；在妊娠后期，持续暴露与早产之间的关系更为密切。结论妊娠期间，特别是妊娠中期和晚期继续使用抗抑郁药的孕妇，其不良分娩结局的风险可能更高。这一证据应与抑郁症复发相关的风险一并考虑。
BackgroundLittle is known about antidepressant medication use patterns during pregnancy among periconception (before and immediately following conception) users. Additionally, the associations between these patterns and birth outcomes is unclear, after taking into account underlying depression severity.ObjectiveThis study describes patterns of antidepressant use among periconception users and examines associations between usage patterns and birth outcomes.Study DesignThis retrospective cohort study included pregnant Kaiser Permanente Northern California (KPNC) members with a live birth between 2014 and 2017 and an antidepressant medication fill that overlapped the 8th week of pregnancy. Outcomes were preterm birth and neonatal intensive care unit (NICU) admission. Data were extracted from KPNC's electronic health records. Modified Poisson regression was conducted.ResultsOf the 3637 pregnancies meeting inclusion criteria, 33% (n= 1204) continued antidepressant use throughout the pregnancy (refilled throughout pregnancy), 47% (n= 1721) discontinued use (no refills), and 20% (n= 712) stopped and reinitiated use (refill after 30+ day gap in supply). Women who continued use had 1.86 (95% confidence interval (CI) 1.53, 2.27) times the risk of preterm birth and 1.76 (95% CI: 1.42, 2.19) times the risk of NICU admission, compared to women who discontinued use during pregnancy. Similarly, women with continued use had 1.66 (95% CI: 1.27, 2.18) times the risk of preterm birth and 1.85 (95% CI: 1.39, 2.46) times the risk of NICU admission, compared to women who stopped and reinitiated use. This relationship held when examining continuous exposure; the relationship between continuous exposure and preterm delivery was stronger in later trimesters.ConclusionsPericonception antidepressant users who continue use during pregnancy, particularly into the second and third trimesters, may be at higher risk of adverse birth outcomes. This evidence should be considered alongside the risks associated with depression relapse.