Ramos E, Oraichi D, Rey E, Blais L, Bérard A
Research Center, CHU Sainte-Justine Hosptial, Montreal, Quebec, Canada.
BJOG. 2007 Sep;114(9):1055-64. doi: 10.1111/j.1471-0528.2007.01387.x. Epub 2007 Jun 12.
(1) To determine the prevalence of antidepressant utilisation before, during, and after pregnancy, (2) to determine switches, dosages, and classes of antidepressant used during pregnancy, and (3) to identify factors associated with their use at the beginning and at the end of pregnancy.
Retrospective longitudinal cohort.
The 'Medication and Pregnancy' cohort was used for this study. This cohort was built by the linkage of three administrative databases (Régie de l'Assurance Maladie du Québec [RAMQ], Med-Echo, and l'Institut de la Statistique du Québec).
All pregnancies occuring in Quebec between January 1 1998 and December 31 2002.
Date of entry in the cohort was the first day of gestation. To be eligible for this study, women had to be (1) 15-45 years old at cohort entry and (2) covered by the RAMQ drug plan for at least 12 months before, during, and at least 12 months after pregnancy. Antidepressant users were defined as those receiving at least one antidepressant before, during, or after pregnancy, depending on the time period analysed. Logistic regression models were used to identify factors associated with receiving an antidepressant either at the beginning or at the end of pregnancy.
To determine the prevalence and predictors associated with the use of antidepressants.
A total of 97,680 women met inclusion criteria. The prevalence rates significantly declined during the first trimester compared with before pregnancy (3.7 versus 6.6%, P < 0.01). During pregnancy, antidepressants were used under the recommended daily dosage 7.7% of the time, and 4.7% of women switched to another class of antidepressant. Factors significantly associated with antidepressant utilisation on the first day of gestation (P < 0.05) were older maternal age, being on welfare, and calendar year; receiving at least six different types of medications other than antidepressants, having at least two different prescribers, having at least three visits to the physician, and having at least one diagnosis of depression in the year before pregnancy also increased the odds of having an antidepressant. Similar predictors were found at the end of pregnancy.
Our findings indicate that antidepressant utilisation declines once pregnancy is diagnosed.
（1）确定孕期前、孕期和产后抗抑郁药的使用情况；（2）确定孕期使用的抗抑郁药的换药情况、剂量和种类；（3）识别孕期开始和结束时与抗抑郁药使用相关的因素。
回顾性纵向队列研究。
本研究使用了“药物与妊娠”队列。该队列通过三个行政数据库（魁北克医疗保险局[RAMQ]、Med-Echo和魁北克统计局）的关联构建而成。
1998年1月1日至2002年12月31日期间在魁北克发生的所有妊娠。
队列进入日期为妊娠第一天。符合本研究条件的女性必须满足：（1）队列进入时年龄在15至45岁之间；（2）在孕期前、孕期以及产后至少12个月均纳入魁北克医疗保险局药物计划。抗抑郁药使用者定义为在孕期前、孕期或产后接受过至少一种抗抑郁药治疗的女性，具体取决于所分析的时间段。采用逻辑回归模型识别孕期开始或结束时与接受抗抑郁药治疗相关的因素。
确定抗抑郁药使用的患病率及相关预测因素。
共有97680名女性符合纳入标准。与孕期前相比，孕早期患病率显著下降（3.7%对6.6%，P<0.01）。孕期中，7.7%的时间抗抑郁药使用剂量低于推荐日剂量，4.7%的女性换用了另一类抗抑郁药。与妊娠第一天使用抗抑郁药显著相关的因素（P<0.05）包括产妇年龄较大、领取福利金以及年份；除抗抑郁药外接受至少六种不同类型药物治疗、有至少两名不同的开处方医生、至少看诊三次以及在孕前一年至少有一次抑郁症诊断也增加了使用抗抑郁药的几率。在妊娠结束时发现了类似的预测因素。
我们的研究结果表明，一旦确诊妊娠，抗抑郁药的使用会减少。
