Maternal use of selective serotonin re-uptake inhibitors in early pregnancy and infant congenital malformations
Maternal use of selective serotonin re-uptake inhibitors in early pregnancy and infant congenital malformations
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DOI：
10.1002/bdra.20327
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发表时间：
2007-04-01
影响因子：
--
通讯作者：
Olausson, Petra Otterblad
中科院分区：
文献类型：
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作者：
Kallen, Bengt A. J.;Olausson, Petra Otterblad
背景：最近，母亲使用选择性血清素再摄取抑制剂（SSRIs）与某些畸形的风险增加有关。方法：使用瑞典出生登记，我们确定了在怀孕早期报告使用SSRIs的妇女，并研究了1995年7月1日至2004年底出生的婴儿。先天性畸形从该登记簿、先天性畸形登记簿和出院登记簿中确定。药物暴露的影响是在调整了一些可能作为混杂因素的已确定的母亲特征后研究的。结果：我们确定了6,481名报告在妊娠早期使用SSRIs的妇女及其6,555名婴儿。畸形风险没有普遍增加。囊性肾的风险增加了，但这只是基于9个畸形婴儿，这些病例的病理各不相同。一项对心血管缺陷的深入研究发现，这类缺陷与母亲使用帕罗西汀而非其他SSRls之间存在关联，尤其是室间隔和房间隔缺陷。没有证据支持SSRI的使用与婴儿颅狭窄或脐膨出之间的关联。结论：妊娠早期使用SSRIs似乎不是婴儿畸形的主要危险因素。帕罗西汀的使用与婴儿心血管缺陷之间的联系可能是多项试验的结果，但也得到了其他研究的支持。
BACKGROUND: Maternal use of selective serotonin re-uptake inhibitors (SSRIs) has recently been associated with an increased risk for certain malformations. METHODS: Using the Swedish Medical Birth Register, we identified women who had reported the use of SSRIs in early pregnancy and studied their infants, born between July 1, 1995 and the end of 2004. Congenital malformations were identified from that register, from the Register of Congenital Malformations, and from the Hospital Discharge Register. The effect of drug exposure was studied after adjustment for a number of identified maternal characteristics that could act as confounders. RESULTS: We identified 6,481 women who reported the use of SSRIs in early pregnancy and their 6,555 infants. There was no general increase in malformation risk. An increased risk for cystic kidneys was seen, but this was based on only nine malformed infants, and the pathology varied between these cases. An in-depth study of cardiovascular defects identified an association between such defects and notably ventricular and atrial septum defects and maternal use of paroxetine but not other SSRls. No support for a postulated association between SSRI use and infant craniostenosis or omphalocele was found. CONCLUSIONS: Use of SSRIs in early pregnancy does not seem to be a major risk factor for infant malformations. The association between paroxetine use and infant cardiovascular defects may be a result of multiple testing, but is supported by other studies.