First-trimester use of selective serotonin-reuptake inhibitors and the risk of birth defects
First-trimester use of selective serotonin-reuptake inhibitors and the risk of birth defects
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DOI：
10.1056/nejmoa067407
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发表时间：
2007-06-28
影响因子：
158.5
通讯作者：
Mitchell, Allen A.
中科院分区：
文献类型：
--
作者：
Louik, Carol;Lin, Angela E.;Mitchell, Allen A.
背景：产前暴露于选择性降钙素再摄取抑制剂（SSRIs）后出生缺陷的风险仍然存在争议。方法：我们评估了妊娠早期母亲使用SSRIs与参与斯隆流行病学中心出生缺陷研究的9849名出生缺陷婴儿和5860名无出生缺陷婴儿出生缺陷风险之间的关系。（涉及42项比较），SSRIs的总体使用与颅缝早闭的风险显著增加无关（115名受试者，2名暴露于SSRI;比值比，0.8; 95%置信区间[CI]，0.2至3.5），脐膨出（127例受试者，3例暴露;比值比，1.4; 95% CI，0.4 - 4.5）或总体心脏缺陷（3724例受试者，100例暴露;比值比，1.2; 95% CI，0.9 - 1.6）。对个体SSRIs和特定缺陷之间关系的分析显示舍曲林的使用和脐膨出之间有显著关系（比值比，5.7; 95% CI，1.6 - 20.7; 3例暴露受试者）和间隔缺损（比值比，2.0; 95% CI，1.2 - 4.0; 13例暴露受试者）以及使用帕罗西汀与右心室流出道梗阻缺陷之间的关系（比值比，3.3; 95% CI，1.3 - 8.8; 6例暴露受试者）。其他缺陷或其他SSRI或非SSRI抗抑郁药的风险没有明显或显著增加。探索性分析，涉及66个比较显示可能的协会帕罗西汀和舍曲林与其他具体defects.CONCLUSIONS：我们的研究结果并没有显示，有显着增加的风险颅缝早闭，脐膨出，或心脏缺陷与SSRI使用整体。他们认为，个别SSRIs可能会增加某些特定缺陷的风险，但应该认识到，所涉及的特定缺陷是罕见的，绝对风险很小。
BACKGROUND:The risk of birth defects after antenatal exposure to selective serotonin-reuptake inhibitors (SSRIs) remains controversial.METHODS:We assessed associations between first-trimester maternal use of SSRIs and the risk of birth defects among 9849 infants with and 5860 infants without birth defects participating in the Slone Epidemiology Center Birth Defects Study.RESULTS:In analyses of defects previously associated with SSRI use (involving 42 comparisons), overall use of SSRIs was not associated with significantly increased risks of craniosynostosis (115 subjects, 2 exposed to SSRIs; odds ratio, 0.8; 95% confidence interval [CI], 0.2 to 3.5), omphalocele (127 subjects, 3 exposed; odds ratio, 1.4; 95% CI, 0.4 to 4.5), or heart defects overall (3724 subjects, 100 exposed; odds ratio, 1.2; 95% CI, 0.9 to 1.6). Analyses of the associations between individual SSRIs and specific defects showed significant associations between the use of sertraline and omphalocele (odds ratio, 5.7; 95% CI, 1.6 to 20.7; 3 exposed subjects) and septal defects (odds ratio, 2.0; 95% CI, 1.2 to 4.0; 13 exposed subjects) and between the use of paroxetine and right ventricular outflow tract obstruction defects (odds ratio, 3.3; 95% CI, 1.3 to 8.8; 6 exposed subjects). The risks were not appreciably or significantly increased for other defects or other SSRIs or non-SSRI antidepressants. Exploratory analyses involving 66 comparisons showed possible associations of paroxetine and sertraline with other specific defects.CONCLUSIONS:Our findings do not show that there are significantly increased risks of craniosynostosis, omphalocele, or heart defects associated with SSRI use overall. They suggest that individual SSRIs may confer increased risks for some specific defects, but it should be recognized that the specific defects implicated are rare and the absolute risks are small.