Association between antidepressant use during pregnancy and miscarriage: a systematic review and meta-analysis.
Association between antidepressant use during pregnancy and miscarriage: a systematic review and meta-analysis.
复制标题
DOI：
10.1136/bmjopen-2023-074600
复制
发表时间：
2024-01-25
期刊：
影响因子：
2.9
通讯作者：
Forbes, Harriet
中科院分区：
文献类型：
--
作者：
Smith, Sophie;Martin, Flo;Rai, Dheeraj;Forbes, Harriet
关于妊娠期间使用抗抑郁药与流产之间的关系的文献是相互矛盾的。我们的目的是对孕妇与未接触抗抑郁药的孕妇相比，在怀孕期间接触抗抑郁药与流产风险之间的关系进行系统回顾和荟萃分析。我们对非随机研究进行了系统回顾和荟萃分析。我们检索了截至2023年8月6日的Medline、Embase和PsychINFO。如果将妊娠期间暴露于任何抗抑郁药类别的个体与未使用抗抑郁药或替代抗抑郁药的对照组进行比较，则选择病例对照、队列和横断面研究设计。从选定的研究中提取效应估计值，并使用随机效应荟萃分析进行汇总。使用非随机干预研究偏倚风险（ROBINS-I）工具评估偏倚风险（RoB），并使用I2统计量评估异质性。亚组分析用于探索抗抑郁药类别和适应症混杂的影响。从检索中识别出1800条记录，其中29条被纳入系统综述和荟萃分析。总样本包括5 671 135人。与一般人群中未暴露的个体相比，抗抑郁药使用者最初似乎具有更高的流产风险（汇总效应估计值：1.24，95% CI 1.18 - 1.31，I2=69.2%;研究数量（n）=29）。然而，与未暴露的母亲抑郁症患者相比，汇总估计值降低（1.16，1.04至1.31; I2=58.6%; n=6），表明适应症的混杂可能导致相关性。22项研究存在严重RoB，29项研究中只有2项被视为中度RoB。在解释了母亲的抑郁症之后，几乎没有证据表明怀孕期间使用抗抑郁药与流产之间存在任何联系。相反，结果表明了适应症混杂的偏倚影响。
Literature surrounding the association between antidepressant use during pregnancy and miscarriage is conflicting. We aimed to conduct a systematic review and meta-analysis of studies among pregnant women regarding the association between exposure to antidepressants during pregnancy and the risk of miscarriage, compared with pregnant women not exposed to antidepressants. We conducted a systematic review and meta-analysis of non-randomised studies. We searched Medline, Embase and PsychINFO up to 6 August 2023. Case-control, cohort and cross-sectional study designs were selected if they compared individuals exposed to any antidepressant class during pregnancy to comparator groups of either no antidepressant use or an alternate antidepressant. Effect estimates were extracted from selected studies and pooled using a random-effects meta-analysis. Risk of bias (RoB) was assessed using the Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool, and heterogeneity assessed using the I2 statistic. Subgroup analyses were used to explore antidepressant classes and the impact of confounding by indication. 1800 records were identified from the search, of which 29 were included in the systematic review and meta-analysis. The total sample included 5 671 135 individuals. Antidepressant users initially appeared to have a higher risk of miscarriage compared with unexposed individuals from the general population (summary effect estimate: 1.24, 95% CI 1.18 to 1.31, I2=69.2%; number of studies (n)=29). However, the summary estimate decreased when comparing against unexposed individuals with maternal depression (1.16, 1.04 to 1.31; I2=58.6%; n=6), suggesting confounding by indication may be driving the association. 22 studies suffered from serious RoB, and only two of the 29 studies were deemed at moderate RoB. After accounting for maternal depression, there is little evidence of any association between antidepressant use during pregnancy and miscarriage. Instead, the results indicate the biasing impact of confounding by indication.
登录
查看更多内容
影响因子：
9.8
作者：
Chun-Fai-Chan, B;Koren, G;Einarson, A
通讯作者：
Einarson, A
影响因子：
9.3
作者：
Kato T;Furukawa TA;Mantani A;Kurata K;Kubouchi H;Hirota S;Sato H;Sugishita K;Chino B;Itoh K;Ikeda Y;Shinagawa Y;Kondo M;Okamoto Y;Fujita H;Suga M;Yasumoto S;Tsujino N;Inoue T;Fujise N;Akechi T;Yamada M;Shimodera S;Watanabe N;Inagaki M;Miki K;Ogawa Y;Takeshima N;Hayasaka Y;Tajika A;Shinohara K;Yonemoto N;Tanaka S;Zhou Q;Guyatt GH;SUN☺D Investigators
通讯作者：
SUN☺D Investigators
影响因子：
9.8
作者：
Cooper, William O.;Willy, Mary E.;Ray, Wayne A.
通讯作者：
Ray, Wayne A.
DOI：
10.1016/j.reprotox.2020.04.007
发表时间：
2020-10-01
期刊：
Reproductive toxicology (Elmsford, N.Y.)
影响因子：
--
作者：
Bahat, M;Shechtman, S;Diav-Citrin, O
通讯作者：
Diav-Citrin, O
DOI：
10.1177/070674370304800207
发表时间：
2003-03-01
影响因子：
4
作者：
Einarson, Adrienne;Bonari, Lori;Koren, Gideon
通讯作者：
Koren, Gideon