Antidepressant use during pregnancy and the risk of preterm delivery and fetal growth restriction.
Antidepressant use during pregnancy and the risk of preterm delivery and fetal growth restriction.
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DOI：
10.1097/jcp.0b013e3181bf344c
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发表时间：
2009-12
影响因子：
2.9
通讯作者：
Hernández-Díaz S
中科院分区：
文献类型：
--
作者：
Toh S;Mitchell AA;Louik C;Werler MM;Chambers CD;Hernández-Díaz S
产前接触抗抑郁药物与早产和胎儿生长受限之间的关系存在争议，而且人们对此知之甚少。我们研究了抗抑郁药物的使用与这些结果之间的关系。分析包括 1998 年至 2008 年间接受斯隆流行病学中心出生缺陷研究采访的非畸形婴儿的妇女。我们估计了早产儿和小于胎龄 (SGA) 后代的比值比 (OR) 和 95% 置信区间 (CI)，并调整了社会人口、生活方式、医疗和生殖因素。 5710 名非使用者（参考）中的早产频率为 7.3%，192 名选择性血清素再摄取抑制剂 (SSRI) 使用者中的早产率为 8.9%（OR，1.1；95% CI，0.6–2.0），59 名非 SSRI 抗抑郁药使用者中的早产率为 15.3%（OR，2.2；95% CI， 1.0–4.9）；生育 SGA 后代的频率分别为 7.2%、10.9%（OR，1.7；95% CI，1.0-2.7）和 13.6%（OR，2.2；95% CI，1.0-4.9）。与未服用 SSRI 的 106 名妇女相比，在妊娠头三个月结束前停用 SSRI 的妇女的早产率 (7.6%) 和 SGA 后代 (5.7%) 的发生率并未增加。在妊娠早期继续服用 SSRIs 的女性中，10.5% 产下早产儿（OR，1.3；95% CI，0.6-2.8），17.4% 生出 SGA 后代（OR，3.0；95% CI，1.7-5.5）。在怀孕后期接受 SSRI 治疗的女性生出 SGA 婴儿的频率较高，而接受非 SSRI 抗抑郁药治疗的女性则更有可能生出早产和 SGA 后代。研究结果表明潜在的情绪障碍的影响或两类药物共有的影响。无论如何，产前使用抗抑郁药物可能有助于识别早产儿和 SGA 婴儿风险较高的女性。
The associations between prenatal exposure to antidepressants and preterm delivery and fetal growth restriction are controversial and poorly understood. We studied the relation between antidepressant use and these outcomes. Analysis included women with nonmalformed infants interviewed in the Slone Epidemiology Center Birth Defects Study between 1998 and 2008. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) for premature and small-for–gestational age (SGA) offsprings, adjusting for sociodemographic, lifestyle, medical, and reproductive factors. The frequencies of preterm delivery were 7.3% among the 5710 nonusers (reference), 8.9% among the 192 selective serotonin reuptake inhibitor (SSRI) users (OR, 1.1; 95% CI, 0.6–2.0), and 15.3% among the 59 non-SSRI antidepressant users (OR, 2.2; 95% CI, 1.0–4.9); the respective frequencies of delivering an SGA offspring were 7.2%, 10.9% (OR, 1.7; 95% CI, 1.0–2.7), and 13.6% (OR, 2.2; 95% CI, 1.0–4.9). Compared with nonusers, the frequencies of preterm delivery (7.6%) and SGA offspring (5.7%) were not increased among the 106 women who discontinued SSRIs before the end of the first trimester. Among women who continued SSRIs beyond the first trimester, 10.5% delivered a preterm infant (OR, 1.3; 95% CI, 0.6–2.8) and 17.4% had an SGA offspring (OR, 3.0; 95% CI, 1.7–5.5). Women treated with SSRIs late in pregnancy had a higher frequency of delivering SGA infants, and women receiving non-SSRI antidepressants were more likely to deliver premature and SGA offsprings. The findings suggest an effect of underlying mood disorder or an effect common to both drug classes. In any case, prenatal antidepressant use may help identify women at elevated risks of delivering preterm and SGA infants.