Antidepressant use in pregnancy and the risk of cardiac defects.
Antidepressant use in pregnancy and the risk of cardiac defects.
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DOI：
10.1097/01.aoa.0000463845.01058.75
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发表时间：
2014-06
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影响因子：
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通讯作者：
K. Huybrechts;K. Palmsten;J. Avorn;L. Cohen;L. Holmes;J. Franklin;H. Mogun;R. Levin;Mary K. Kowal;S. Setoguchi;S. Hernández-Díaz
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作者：
K. Huybrechts;K. Palmsten;J. Avorn;L. Cohen;L. Holmes;J. Franklin;H. Mogun;R. Levin;Mary K. Kowal;S. Setoguchi;S. Hernández-Díaz
背景：妊娠期间使用选择性5-羟色胺再摄取抑制剂(SSRI)和其他抗抑郁药是否会增加先天性心脏缺陷的风险尚不确定。特别是，人们担心帕罗西汀的使用与右室流出道梗阻以及舍曲林的使用与室间隔缺陷之间可能存在关联。方法我们在2000年至2007年期间进行了一项嵌套在全国医疗补助分析摘录中的队列研究。这项研究包括949,504名在最后一次月经前3个月至分娩后1个月期间登记参加医疗补助的孕妇及其活着的婴儿。我们比较了在怀孕前三个月服用抗抑郁药物的妇女所生婴儿的主要心脏缺陷的风险与未使用抗抑郁药物的妇女所生婴儿的风险，进行了一项未调整的分析和分析，将队列限制在患有抑郁症的妇女身上，并使用倾向得分调整来控制抑郁的严重程度和其他潜在的混杂因素。结果共有64,389名妇女(6.8%)在妊娠早期使用抗抑郁药物。总体而言，未接触抗抑郁药的6403名婴儿出生时患有心脏缺陷(每10,000名婴儿中有72.3名婴儿患有心脏缺陷)，而接触抗抑郁药的婴儿为580名(每10,000名婴儿中有90.1名)。抗抑郁药的使用和心脏缺陷之间的关联随着混杂调整水平的增加而减弱。使用SSRIs的任何心脏缺陷的相对风险在未校正分析中为1.25(95%可信区间，1.13至1.38)，在仅限于抑郁症女性的分析中为1.12(95%CI，1.00至1.26)，在完全校正分析中为1.06(95%CI，0.93至1.22)。我们发现使用帕罗西汀与右室流出道梗阻(相对风险为1.07；95%可信区间为0.59至1.93)或舍曲林的使用与室间隔缺损(相对风险为1.04；95%可信区间为0.76至1.41)之间没有显著相关性。结论：这项以人群为基础的大型队列研究结果表明，在妊娠早期使用抗抑郁药导致心脏畸形的风险没有显著增加。(由卫生保健研究和质量机构和美国国立卫生研究院资助。)
BACKGROUND Whether the use of selective serotonin-reuptake inhibitors (SSRIs) and other antidepressants during pregnancy is associated with an increased risk of congenital cardiac defects is uncertain. In particular, there are concerns about a possible association between paroxetine use and right ventricular outflow tract obstruction and between sertraline use and ventricular septal defects. METHODS We performed a cohort study nested in the nationwide Medicaid Analytic eXtract for the period 2000 through 2007. The study included 949,504 pregnant women who were enrolled in Medicaid during the period from 3 months before the last menstrual period through 1 month after delivery and their liveborn infants. We compared the risk of major cardiac defects among infants born to women who took antidepressants during the first trimester with the risk among infants born to women who did not use antidepressants, with an unadjusted analysis and analyses that restricted the cohort to women with depression and that used propensity-score adjustment to control for depression severity and other potential confounders. RESULTS A total of 64,389 women (6.8%) used antidepressants during the first trimester. Overall, 6403 infants who were not exposed to antidepressants were born with a cardiac defect (72.3 infants with a cardiac defect per 10,000 infants), as compared with 580 infants with exposure (90.1 per 10,000 infants). Associations between antidepressant use and cardiac defects were attenuated with increasing levels of adjustment for confounding. The relative risks of any cardiac defect with the use of SSRIs were 1.25 (95% confidence interval [CI], 1.13 to 1.38) in the unadjusted analysis, 1.12 (95% CI, 1.00 to 1.26) in the analysis restricted to women with depression, and 1.06 (95% CI, 0.93 to 1.22) in the fully adjusted analysis restricted to women with depression. We found no significant association between the use of paroxetine and right ventricular outflow tract obstruction (relative risk, 1.07; 95% CI, 0.59 to 1.93) or between the use of sertraline and ventricular septal defects (relative risk, 1.04; 95% CI, 0.76 to 1.41). CONCLUSIONS The results of this large, population-based cohort study suggested no substantial increase in the risk of cardiac malformations attributable to antidepressant use during the first trimester. (Funded by the Agency for Healthcare Research and Quality and the National Institutes of Health.).