Antidepressant prescriptions, discontinuation, depression and perinatal outcomes, including breastfeeding: A population cohort analysis
Antidepressant prescriptions, discontinuation, depression and perinatal outcomes, including breastfeeding: A population cohort analysis
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DOI：
10.1371/journal.pone.0225133
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发表时间：
2019-11-18
期刊：
影响因子：
3.7
通讯作者：
Humphreys, Ioan
中科院分区：
文献类型：
--
作者：
Jordan, Sue;Davies, Gareth I.;Humphreys, Ioan
目的 探讨接触抗抑郁药、停药、抑郁症（药物或非药物治疗）与早产 [< 37 周和 < 32 周]、小于胎龄 (SGA) [< 10 和 < 3 百分位]、6-8 周母乳喂养 [任何] 之间的关联。方法设计：一项基于人群的队列研究。设置：威尔士安全匿名信息链接 [SAIL] 数据库，链接母亲初级保健数据与婴儿结局。参与者：2000-2010 年出生的 107,573、105,331 和 38,725 名婴儿，在排除后分别提供有关早产、SGA 和母乳喂养的信息。暴露：母亲在第 2 或第 3 个月服用抗抑郁药，第 1 个月后停药，记录抑郁症诊断（药物或非药物治疗）方法：计算不良妊娠结局的比值比，并根据吸烟、产次、社会经济状况和抑郁进行调整。结果 6-8 周时纯配方奶喂养与妊娠第 2 或第 3 个月服用任何抗抑郁药物的处方相关（调整比值比 [aOR] 0.81，95% 置信区间 0.67-0.98）、SSRIs [aOR 0.77， 0.62-0.95]，特别是较高剂量 [aOR 0.45, 0.23-0.86]，妊娠 1 后停用抗抑郁药或 SSRI（aOR 0.70, 0.57-0.83 和 0.66, 0.51-0.87），诊断抑郁症 aOR 0.76 [0.70-0.82]，特别是如果服用药物（aOR 0.70、0.58-0.85），而不是未服用药物（aOR 0.87、0.82-0.92）。妊娠 < 37 周和 < 32 周的早产与抑郁症的诊断相关（aOR 1.27、1.17-1.38 和 1.33、1.09-1.62），特别是在接受药物治疗时（aOR 1.56、1.23-1.96 和 1.63、0.94-2.84）； < 37 周出生与抗抑郁药相关 (aOR 1.24, 1.04-1.49]。SGA < 3% 与抗抑郁药 (aOR 1.43, 1.07-1.90) 和 SSRIs (aOR 1.46, 1.06-2.00]，特别是较高剂量相关 [aOR 2.10, 1.32-3.34]。所有不良后果均与社会经济状况和吸烟有关。
ObjectivesTo explore associations between exposure to antidepressants, their discontinuation, depression [medicated or unmediated] and preterm birth [< 37 and < 32 weeks], small for gestational age (SGA) [< 10th and < 3rd centiles], breastfeeding [any] at 6-8 weeks.MethodsDesign: A population-based cohort study.Setting: The Secure Anonymised Information Linkage [SAIL] databank in Wales, linking maternal primary care data with infant outcomes.Participants: 107,573, 105,331, and 38,725 infants born 2000-2010 with information on prematurity, SGA and breastfeeding respectively, after exclusions.Exposures: Maternal antidepressant prescriptions in trimesters 2 or 3, discontinuation after trimester 1, recorded diagnosis of depression [medicated or unmediated] in pregnancy.Methods: Odds ratios for adverse pregnancy outcomes were calculated, adjusted for smoking, parity, socio-economic status, and depression.ResultsExclusive formula feeding at 6-8 weeks was associated with prescriptions in trimesters 2 or 3 for any antidepressants (adjusted odds ratio [aOR] 0.81, 95% confidence intervals 0.67-0.98), SSRIs [aOR 0.77, 0.62-0.95], particularly higher doses [aOR 0.45, 0.23-0.86], discontinuation of antidepressants or SSRIs after trimester 1 (aOR 0.70, 0.57-0.83 and 0.66, 0.51-0.87), diagnosis of depression aOR 0.76 [0.70-0.82), particularly if medicated (aOR 0.70, 0.58-0.85), rather than unmedicated (aOR 0.87, 0.82-0.92). Preterm birth at < 37 and < 32 weeks' gestation was associated with diagnosis of depression (aOR 1.27, 1.17-1.38, and 1.33, 1.09-1.62), particularly if medicated (aOR 1.56, 1.23-1.96, and 1.63, 0.94-2.84); birth at < 37 weeks was associated with antidepressants, (aOR 1.24, 1.04-1.49]. SGA < 3rd centile was associated with antidepressants (aOR 1.43, 1.07-1.90), and SSRIs (aOR 1.46, 1.06-2.00], particularly higher doses [aOR 2.10, 1.32-3.34]. All adverse outcomes were associated with socio-economic status and smoking.