A population-based study of concurrent prescriptions of opioid analgesic and selective serotonin reuptake inhibitor medications during pregnancy and risk for adverse birth outcomes.
A population-based study of concurrent prescriptions of opioid analgesic and selective serotonin reuptake inhibitor medications during pregnancy and risk for adverse birth outcomes.
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妊娠期间阿片类镇痛药和选择性5-羟色胺再摄取抑制剂药物的同时处方与不良出生结局风险的人群研究
DOI：
10.1111/ppe.12721
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发表时间：
2021-03
影响因子：
2.8
通讯作者：
D'Onofrio BM
中科院分区：
文献类型：
--
作者：
Sujan AC;Rickert ME;Quinn PD;Ludema C;Wiggs KK;Larsson H;Lichtenstein P;Almqvist C;Öberg AS;D'Onofrio BM
有痛苦状况的孕妇通常有心理健康问题，包括抑郁和焦虑。并存的情况可能会导致孕妇使用多种药物，尽管这种做法的安全性尚不清楚。我们调查了怀孕期间阿片类镇痛剂和选择性5-羟色胺再摄取抑制剂(SSRIs)的联合处方对两种不良分娩结局的影响。我们分析了2007至2013年间瑞典以人口为基础的出生人口(n=688,914)。使用国家登记，我们获得了关于填写的药物处方、出生结局和广泛的父母特征的数据。我们估计了单独或联合服用这两种药物后早产和胎龄风险较小，而这两种药物均未开满处方。我们使用治疗权重的逆概率调整了混杂因素。在调整混杂因素后，仅服用阿片类止痛药的妇女早产风险(5.9%；风险比[RR]1.27，95%可信区间[CI]1.22，1.33)，仅服用SSRIs(6.2%；RR 1.34，95%CI 1.27，1.42)，以及两种药物同时服用(7.8%；RR 1.70，95%CI 1.47，1.96)的早产风险高于未服用阿片类止痛药的妇女(4.6%)。两种药物对早产的交互作用较小(风险差异[RD]0.4%，95%CI−0.8%，1.6%)；交互作用相对超额风险[RERI0.09，95%CI−0.17，0.34；RR 1.00，95%CI 0.85，1.17]。对于小于胎龄儿，所有组的风险约为2%，并且药物之间没有交互作用(RD 0.3%，95%CI−0.4%，1.1%)；RERI0.15，95%CI−0.16，0.47；RR 1.15，95%CI 0.87，1.52)。与未暴露的妊娠相比，那些单独服用任何一种药物的人早产的风险略有增加，但对小于胎龄的风险没有增加。联合接触两种药物的关联程度不大于单独考虑的每种药物关联的总和。
Pregnant women with painful conditions often have mental health problems, including depression and anxiety. Comorbid conditions may cause pregnant women to use multiple medications, although safety of such practice is poorly understood. We investigated the influence of combined prescriptions of opioid analgesics and selective-serotonin reuptake inhibitors (SSRIs) during pregnancy on two adverse birth outcomes. We analyzed Swedish population-based births (n=688,914) between 2007 and 2013. Using national registers, we obtained data on filled medication prescriptions, birth outcomes, and a wide range of parental characteristics. We estimated preterm birth and small for gestational age risk following independent or combined prescriptions of the two medications compared with no filled prescriptions for either medication. We adjusted for confounders using inverse probability of treatment weights. After adjusting for confounders, preterm birth risk was higher among women with opioid analgesic prescriptions only (5.9%; risk ratio [RR] 1.27, 95% confidence interval [CI] 1.22, 1.33), SSRIs only (6.2%; RR 1.34, 95% CI 1.27, 1.42), and both medications (7.8%; RR 1.70, 95% CI 1.47, 1.96) compared with unexposed women (4.6%). The interaction between the medications on preterm birth was small (risk difference [RD] 0.4%, 95% CI −0.8%, 1.6%); relative excess risk due to interaction [RERI] 0.09, 95% CI −0.17, 0.34; RR 1.00, 95% CI 0.85, 1.17). For small for gestational age, risk was approximately 2% across all groups, and there was no interaction between the medications (RD 0.3%, 95% CI −0.4%, 1.1%); RERI 0.15, 95% CI −0.16, 0.47; RR 1.15, 95% CI 0.87, 1.52). Compared with unexposed pregnancies, those with either medication alone had a small increased risk for preterm birth but no increased risk for small for gestational age. The magnitude of associations with combined exposure to both medications were not greater than the sum of the associations with each medication considered individually.
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影响因子：
4.2
作者：
Abrahamsson, Tove;Berge, Jonas;Hakansson, Anders
通讯作者：
Hakansson, Anders
影响因子：
17.7
作者：
Fazel, Seena;Grann, Martin
通讯作者：
Grann, Martin
DOI：
10.1177/140349489001800209
发表时间：
1990-01-01
期刊：
SCANDINAVIAN JOURNAL OF SOCIAL MEDICINE
影响因子：
--
作者：
CNATTINGIUS, S;ERICSON, A;KALLEN, B
通讯作者：
KALLEN, B
影响因子：
5
作者：
Cole, Stephen R.;Hernan, Miguel A.
通讯作者：
Hernan, Miguel A.
影响因子：
--
作者：
D'Onofrio, Brian M.;Singh, Amber L.;Iliadou, Anastasia;Lambe, Mats;Hultman, Christina M.;Grann, Martin;Neiderhiser, Jenae M.;Langstrom, Niklas;Lichtenstein, Paul
通讯作者：
Lichtenstein, Paul