The use of antipsychotic agents during pregnancy and the risk of gestational diabetes mellitus: a systematic review and meta-analysis
The use of antipsychotic agents during pregnancy and the risk of gestational diabetes mellitus: a systematic review and meta-analysis
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妊娠期间抗精神病药物的使用和妊娠糖尿病的风险：系统评价和荟萃分析
作者：
Z. Wang;I. Wong;Kenneth K C Man;B. Alfageh;P. Mongkhon;R. Brauer
摘要背景以前的研究发现，妊娠期间使用抗精神病药物与妊娠期糖尿病（GDM）风险之间存在矛盾的结果。我们的目的是评估妊娠期使用抗精神病药物与GDM之间的关系。方法在PubMed、EMBASE、PsycINFO和科克伦图书馆数据库中进行系统性文献检索，直至2019年3月，以获得评估妊娠期抗精神病药物使用与GDM之间相关性的观察性研究数据。排除非英文研究、动物研究、病例报告、会议摘要、书籍章节、综述和总结。主要结局为GDM。使用随机效应模型合并估计值，使用I2统计量估计结果的异质性。我们的研究方案注册于PROSPERO编号：CRD 42018095014。结果共纳入10项队列研究，其中暴露组6642例，未暴露组1860290例。荟萃分析中纳入了6项研究，总体合并校正相对风险为1.24 [95%置信区间（CI）1.09 - 1.42]。I2结果表明研究间的异质性较低（I2 = 6.7%，p = 0.373）。结论妊娠期使用抗精神病药物与母亲发生GDM的风险增加有关。然而，证据仍然不足，特别是对于特定的毒品类别。我们建议进行更多研究来调查特定药物类别、剂量和合并症的这种相关性，以帮助临床医生在需要在怀孕期间开始或继续服用抗精神病药物处方时管理GDM的风险。
Abstract Background Previous studies have found contradicting results with regard to the use of antipsychotics during pregnancy and the risk of gestational diabetes mellitus (GDM). We aimed to evaluate the association between antipsychotic use in pregnancy and GDM. Methods A systematic literature search was conducted in PubMed, EMBASE, PsycINFO and Cochrane Library databases up to March 2019, for data from observational studies assessing the association between gestational antipsychotic use and GDM. Non-English studies, animal studies, case reports, conference abstracts, book chapters, reviews and summaries were excluded. The primary outcome was GDM. Estimates were pooled using a random effect model, with the I2 statistic used to estimate heterogeneity of results. Our study protocol was registered with PROSPERO number: CRD42018095014. Results In total 10 cohort studies met the inclusion criteria in our systematic review with 6642 exposed and 1 860 290 unexposed pregnancies. Six studies were included in the meta-analysis with a pooled adjusted relative risk of 1.24 overall [95% confidence interval (CI) 1.09–1.42]. The I2 result suggested low heterogeneity between studies (I2 = 6.7%, p = 0.373). Conclusion We found that the use of antipsychotic medications during pregnancy is associated with an increased risk of GDM in mothers. However, the evidence is still insufficient, especially for specific drug classes. We recommend more studies to investigate this association for specific drug classes, dosages and comorbidities to help clinicians to manage the risk of GDM if initiation or continuation of antipsychotic prescriptions during pregnancy is needed.
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影响因子：
9.8
作者：
Mitchell AA;Gilboa SM;Werler MM;Kelley KE;Louik C;Hernández-Díaz S;National Birth Defects Prevention Study
通讯作者：
National Birth Defects Prevention Study
影响因子：
6.1
作者：
Luke, Barbara;Brown, Morton B.
通讯作者：
Brown, Morton B.
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
5
作者：
Scholl, TO;Sowers, M;Lenders, C
通讯作者：
Lenders, C