Elevated Risk of Preeclampsia in Pregnant Women With Depression: Depression or Antidepressants?
Elevated Risk of Preeclampsia in Pregnant Women With Depression: Depression or Antidepressants?
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DOI：
10.1093/aje/kwr394
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发表时间：
2012-05-15
影响因子：
5
通讯作者：
Hernandez-Diaz, Sonia
中科院分区：
文献类型：
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作者：
Palmsten, Kristin;Setoguchi, Soko;Hernandez-Diaz, Sonia
先前的一项研究表明，使用选择性血清素再摄取抑制剂（SSRIs）治疗的女性患先兆子痫的风险增加。作者利用不列颠哥伦比亚省（1997-2006）基于人口的医疗保健利用数据库，对69,448名患有抑郁症的孕妇进行了研究。他们比较了妊娠第10至20周期间服用SSRIs、5 -羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）或三环抗抑郁药（TCAs）的女性与未服用抗抑郁药的女性患先兆子痫的风险。在孕前服用抗抑郁药的妇女中，作者比较了在妊娠10周至24周期间继续服用抗抑郁药的妇女与停止服用抗抑郁药的妇女的风险。估计相对风险和95%置信区间。未接受抗抑郁药物治疗的抑郁症女性患先兆子痫的风险（2.4%）与未患抑郁症的女性相似（2.3%）。与未治疗抑郁症的女性相比，接受SSRI、SNRI和TCA单药治疗的女性调整相对危险度分别为1.22（95%可信区间（CI）： 0.97, 1.54）、1.95 （95% CI: 1.25, 3.03）和3.23 （95% CI: 1.87, 5.59）。在妊娠前使用抗抑郁药的患者中，继续服用SSRI的患者与不服用SSRI的患者相比发生先兆子痫的相对风险为1.32 (95% CI: 0.95, 1.84)， SNRI的患者为3.43 (95% CI: 1.77, 6.65)， TCA单药治疗的患者为3.26 （95% CI: 1.04, 10.24）。研究结果表明，怀孕期间服用抗抑郁药的女性，尤其是SNRIs和TCAs，患先兆子痫的风险更高。这些关联可能反映了药物作用或更严重的抑郁症。
A previous study suggested an increased risk of preeclampsia among women treated with selective serotonin reuptake inhibitors (SSRIs). Using population-based health-care utilization databases from British Columbia (1997-2006), the authors conducted a study of 69,448 pregnancies in women with depression. They compared risk of preeclampsia in women using SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants (TCAs) between gestational weeks 10 and 20 with risk in depressed women not using antidepressants. Among prepregnancy antidepressant users, the authors compared the risk in women who continued antidepressants between gestational weeks 10 and 24 with the risk in those who discontinued. Relative risks and 95% confidence intervals were estimated. The risk of preeclampsia in depressed women not treated with antidepressants (2.4%) was similar to that in women without depression (2.3%). Compared with women with untreated depression, women treated with SSRI, SNRI, and TCA monotherapy had adjusted relative risks of 1.22 (95% confidence interval (CI): 0.97, 1.54), 1.95 (95% CI: 1.25, 3.03), and 3.23 (95% CI: 1.87, 5.59), respectively. Within prepregnancy antidepressant users, the relative risk for preeclampsia among continuers compared with discontinuers was 1.32 (95% CI: 0.95, 1.84) for SSRI, 3.43 (95% CI: 1.77, 6.65) for SNRI, and 3.26 (95% CI: 1.04, 10.24) for TCA monotherapy. Study results suggest that women who use antidepressants during pregnancy, especially SNRIs and TCAs, have an elevated risk of preeclampsia. These associations may reflect drug effects or more severe depression.