Maternal Serotonergic Antidepressant Use in Pregnancy and Risk of Seizures in Children.
Maternal Serotonergic Antidepressant Use in Pregnancy and Risk of Seizures in Children.
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孕产妇血清素能在妊娠中使用抗抑郁药和儿童癫痫发作的风险。
DOI：
10.1212/wnl.0000000000200516
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发表时间：
2022-06-06
期刊：
影响因子：
9.9
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中科院分区：
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评估怀孕期间使用5 -羟色胺类抗抑郁药的妇女所生的孩子是否有更高的新生儿癫痫发作和癫痫风险。我们使用瑞典基于登记的数据来研究1,120万名儿童中报告的孕妇在妊娠期间使用选择性5 -羟色胺再摄取抑制剂（SSRIs）或5 -羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）与新生儿癫痫发作或癫痫诊断之间的关系。为了解释暴露和未暴露儿童之间的系统性差异，我们调整了广泛的测量混杂因素。在首先评估了母亲使用SSRI/SNRI的适应症（即抑郁或焦虑）和父母癫痫的作用后，我们调整了剩余的父母背景因素（如年龄、合并症、教育程度和家庭社会经济指标）和妊娠特异性特征（如母亲在妊娠早期使用其他精神药物和吸烟）。与所有其他儿童相比，报告在怀孕期间使用SSRI/SNRI的妇女的孩子发生新生儿癫痫发作和癫痫的风险升高（风险比[RR] 1.41, 95% CI 1.03-1.94；风险比[HR] 1.21, 95% CI 1.03-1.43）。通过调整母亲使用SSRI/SNRI的适应症（RR 1.30, 95% CI 0.94-1.80; HR 1.13, 95% CI 0.95-1.33），但没有通过父母癫痫史的额外调整来减弱相关性的估计。对所有测量的亲本因素和妊娠特异性因素进行完全调整后，剩余相关性显著减弱（RR 1.10, 95% CI 0.79-1.53; HR 0.96, 95% CI 0.81-1.14）。我们没有发现孕妇在怀孕期间使用SSRI/SNRI会增加儿童发生新生儿癫痫或癫痫的风险。该研究提供了II级证据，表明妊娠前三个月接触SSRIs/SNRIs与新生儿癫痫发作/癫痫发生率增加无关。
To evaluate whether children born to women who use serotonergic antidepressants during pregnancy have higher risk of neonatal seizures and epilepsy. We used Swedish register-based data to examine associations between maternal reported use of selective serotonin reuptake inhibitors (SSRIs) or serotonin–norepinephrine reuptake inhibitors (SNRIs) in pregnancy and diagnosis of neonatal seizures or epilepsy in >1.2 million children. To account for systematic differences between exposed and unexposed children, we adjusted for a wide range of measured confounders. After first evaluating the role of maternal indication for SSRI/SNRI use (i.e., depression or anxiety) and parental epilepsy, we adjusted for remaining parental background factors (e.g., age, comorbidities, education, and family socioeconomic indices) and pregnancy-specific characteristics (e.g., maternal use of other psychotropic medications and tobacco smoking in early pregnancy). Compared with all other children, children of women who reported use of SSRI/SNRI in pregnancy had an elevated risk of neonatal seizures and epilepsy (risk ratio [RR] 1.41, 95% CI 1.03–1.94; hazard ratio [HR] 1.21, 95% CI 1.03–1.43, respectively). The estimates of association were attenuated by adjustment for maternal indications for SSRI/SNRI use (RR 1.30, 95% CI 0.94–1.80; HR 1.13, 95% CI 0.95–1.33), but not by additional adjustment for parental history of epilepsy. Full adjustment for all measured parental and pregnancy-specific factors resulted in substantial attenuation of the remaining associations (RR 1.10, 95% CI 0.79–1.53; HR 0.96, 95% CI 0.81–1.14). We found no support for the concern that maternal SSRI/SNRI use in pregnancy increases children's risk for neonatal seizures or epilepsy. This study provides Class II evidence that exposure to SSRIs/SNRIs in the first trimester of pregnancy is not associated with an increased incidence of neonatal seizures/epilepsy.