Major congenital malformations following prenatal exposure to serotonin reuptake inhibitors and benzodiazepines using population-based health data
Major congenital malformations following prenatal exposure to serotonin reuptake inhibitors and benzodiazepines using population-based health data
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DOI：
10.1002/bdrb.20144
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发表时间：
2008-02-01
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：确定产前暴露于血清素再摄取抑制剂（SRI）抗抑郁药单独使用和与苯二氮卓类药物（BZ）联合使用后先天性异常的人群发生率。方法：将人口健康数据、孕产妇健康和产前处方记录与新生儿记录联系起来，这些记录代表了39个月期间（1998-2001年）所有活产婴儿（加拿大不列颠哥伦比亚省，N = 119,547）。主要先天性异常（CA）和先天性心脏病（CHD），包括心室和房间隔缺陷（VSD， ASD）的发生率和风险差异（RD），与未暴露的结果相比，母亲单独使用SRI、单独使用苯二氮卓类药物（BZ）或SRI+BZ联合治疗的婴儿。结果：与未暴露相比，SRI+BZ联合暴露后CA或CHD的风险确实增加。然而，使用加权回归模型，控制孕产妇疾病特征，联合治疗风险仍然仅与CHID显著相关。在调整了母体协变量后，与未暴露相比，SRI单药治疗的ASD风险更高。剂量/天与风险增加无关。结论：即使在控制了母体疾病特征后，产前暴露于SRIs联合BZs的婴儿与未暴露的婴儿相比，冠心病的发病率更高。SRI单药治疗与主要CA的风险增加无关，但与asd的发生率增加有关。风险与妊娠早期用药剂量/天无关。
BACKGROUND: To determine a population-based incidence of congenital anomalies following prenatal exposure to serotonin reuptake inhibitor (SRI) antidepressants used alone and in combination with a benzodiazepines (BZ). METHODS: Population health data, maternal health, and prenatal prescription records were linked to neonatal records, representing all live births (British Columbia, Canada, N = 119,547) during a 39-month period (1998-2001). The incidence and risk differences (RD) for major congenital anomalies (CA) and congenital heart disease (CHD), including ventricular and atrial septal defects (VSD, ASD), from infants of mothers treated with an SRI alone, a benzodiazepine (BZ) alone, or SRI+BZ in combination compared to outcomesno exposure. RESULTS: Risk for a CA or CHD did increase following combined SRI+BZ exposure compared with no exposure. However, using a weighted regression model, controlling for maternal illness characteristics, combination therapy risk remained significantly associated only with CHID. The risk for an ASD was higher following SRI monotherapy compared with no exposure, after adjustment for maternal covariates. Dose/day was not associated with increased risk. CONCLUSIONS: Infants exposed to prenatal SRIs in combination with BZs had a higher a incidence of CHD compared to no exposure, even after controlling for maternal illness characteristics. SRI monotherapy was not associated with an increased risk for major CA, but was associated with an increased incidence of ASID. Risk was not associated with first trimester medication dose/day.