Placental Complications Associated With Psychostimulant Use in Pregnancy.
Placental Complications Associated With Psychostimulant Use in Pregnancy.
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DOI：
10.1097/aog.0000000000002362
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发表时间：
2017-12
影响因子：
7.2
通讯作者：
Huybrechts KF
中科院分区：
文献类型：
--
作者：
Cohen JM;Hernández-Díaz S;Bateman BT;Park Y;Desai RJ;Gray KJ;Patorno E;Mogun H;Huybrechts KF
评估用于治疗注意缺陷多动障碍（ADHD）的精神兴奋剂是否与不良胎盘相关妊娠结局的风险相关，这些结局包括子痫前期、胎盘早剥、生长受限和早产。
我们设计了一项基于人群的队列研究，对2000年至2010年参加医疗补助计划的一组孕妇及其活产婴儿进行了检查。将在妊娠前半期接受苯丙胺 - 右旋苯丙胺或哌甲酯单一疗法的女性与未暴露的女性进行比较。我们将非兴奋剂ADHD药物托莫西汀作为阴性对照暴露因素。为了评估风险期是否延伸到妊娠后半期，将在20周后继续使用兴奋剂单一疗法的女性与停止使用的女性进行比较。通过倾向评分分层估计风险比（RRs）和95%置信区间（CIs）以控制混杂因素。
将妊娠早期暴露于苯丙胺/右旋苯丙胺（n = 3331）、哌甲酯（n = 1515）和托莫西汀（n = 453）单一疗法的妊娠情况与1461493例未暴露的妊娠情况进行比较。在未暴露的女性中，子痫前期的结局风险为3.7%，胎盘早剥为1.4%，小于胎龄儿为2.9%，早产为11.2%。使用兴奋剂的调整后RR为：子痫前期1.29（95%CI 1.11 - 1.49），胎盘早剥1.13（0.88 - 1.44），小于胎龄儿（SGA）0.91（0.77 - 1.07），早产1.06（0.97 - 1.16）。与停止使用（n = 3527）相比，妊娠后半期继续使用兴奋剂（n = 1319）的调整后RR为：子痫前期1.26（0.94 - 1.67），胎盘早剥1.08（0.67 - 1.74），SGA 1.37（0.97 - 1.93），早产1.30（1.10 - 1.55）。托莫西汀与所研究的结局无关。
妊娠期使用精神兴奋剂与子痫前期和早产的相对风险小幅增加有关。风险的绝对增加幅度较小，因此，不应根据这些发现建议患有严重ADHD的女性暂停其ADHD治疗。
To evaluate whether psychostimulants used to treat attention-deficit hyperactivity disorder (ADHD) are associated with risk of adverse placental-associated pregnancy outcomes including preeclampsia, placental abruption, growth restriction, and preterm birth. We designed a population-based cohort study where we examined a cohort of pregnant women and their liveborn infants enrolled in Medicaid from 2000 to 2010. Women who received amphetamine–dextroamphetamine or methylphenidate monotherapy in the first half of pregnancy were compared to unexposed women. We considered atomoxetine, a non-stimulant ADHD medication, as a negative control exposure. To assess whether the risk period extended to the latter half of pregnancy, women who continued stimulant monotherapy after 20 weeks were compared to those who discontinued. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated with propensity score stratification to control for confounders. Pregnancies exposed to amphetamine/dextroamphetamine (n=3331), methylphenidate (n=1515), and atomoxetine (n=453) monotherapy in early pregnancy were compared to 1,461,493 unexposed pregnancies. Among unexposed women, the risks of the outcomes were 3.7% for preeclampsia, 1.4% for placental abruption, 2.9% for small for gestational age, and 11.2% for preterm birth. The adjusted RR for stimulant use was 1.29 for preeclampsia (95% CI 1.11–1.49), 1.13 for placental abruption (0.88–1.44), 0.91 for small for gestational age (SGA; 0.77–1.07) and 1.06 for preterm birth (0.97–1.16). Compared to discontinuation (n=3527), the adjusted RR for continuation of stimulant use in the latter half of pregnancy (n=1319) was 1.26 for preeclampsia (0.94–1.67), 1.08 for placental abruption (0.67–1.74), 1.37 for SGA (0.97–1.93), and 1.30 for preterm birth (1.10–1.55). Atomoxetine was not associated with the outcomes studied. Psychostimulant use during pregnancy was associated with a small increased relative risk of preeclampsia and preterm birth. The absolute increases in risks are small and thus, women with significant ADHD should not be counseled to suspend their ADHD treatment based on these findings.