Wisner Katherine L, Sit Dorothy K Y, Hanusa Barbara H, Moses-Kolko Eydie L, Bogen Debra L, Hunker Diane F, Perel James M, Jones-Ivy Sonya, Bodnar Lisa M, Singer Lynn T
Women's Behavioral HealthCARE and the Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
Am J Psychiatry. 2009 May;166(5):557-66. doi: 10.1176/appi.ajp.2008.08081170. Epub 2009 Mar 16.
Selective serotonin reuptake inhibitor (SSRI) use during pregnancy incurs a low absolute risk for major malformations; however, other adverse outcomes have been reported. Major depression also affects reproductive outcomes. This study examined whether 1) minor physical anomalies, 2) maternal weight gain and infant birth weight, 3) preterm birth, and 4) neonatal adaptation are affected by SSRI or depression exposure.
This prospective observational investigation included maternal assessments at 20, 30, and 36 weeks of gestation. Neonatal outcomes were obtained by blinded review of delivery records and infant examinations. Pregnant women (N=238) were categorized into three mutually exclusive exposure groups: 1) no SSRI, no depression (N=131); 2) SSRI exposure (N=71), either continuous (N=48) or partial (N=23); and 3) major depressive disorder (N=36), either continuous (N=14) or partial (N=22). The mean depressive symptom level of the group with continuous depression and no SSRI exposure was significantly greater than for all other groups, demonstrating the expected treatment effect of SSRIs. Main outcomes were minor physical anomalies, maternal weight gain, infant birth weight, pregnancy duration, and neonatal characteristics.
Infants exposed to either SSRIs or depression continuously across gestation were more likely to be born preterm than infants with partial or no exposure. Neither SSRI nor depression exposure increased risk for minor physical anomalies or reduced maternal weight gain. Mean infant birth weights were equivalent. Other neonatal outcomes were similar, except 5-minute Apgar scores.
For depressed pregnant women, both continuous SSRI exposure and continuous untreated depression were associated with preterm birth rates exceeding 20%.
孕期使用选择性5-羟色胺再摄取抑制剂（SSRI）导致严重畸形的绝对风险较低；然而，也有其他不良后果的报道。重度抑郁症也会影响生殖结局。本研究调查了1）轻微身体异常、2）孕妇体重增加和婴儿出生体重、3）早产以及4）新生儿适应情况是否受SSRI或抑郁症暴露的影响。
这项前瞻性观察性研究包括在妊娠20、30和36周时对孕妇进行评估。通过对分娩记录和婴儿检查进行盲法审查来获取新生儿结局。将238名孕妇分为三个相互排斥的暴露组：1）未使用SSRI，无抑郁症（n = 131）；2）SSRI暴露（n = 71），持续暴露（n = 48）或部分暴露（n = 23）；3）重度抑郁症（n = 36），持续发作（n = 14）或部分发作（n = 22）。持续抑郁且未暴露于SSRI组的平均抑郁症状水平显著高于所有其他组，这表明了SSRI预期的治疗效果。主要结局包括轻微身体异常、孕妇体重增加、婴儿出生体重、妊娠持续时间和新生儿特征。
在整个孕期持续暴露于SSRI或抑郁症的婴儿比部分暴露或未暴露的婴儿更易早产。SSRI暴露和抑郁症暴露均未增加轻微身体异常的风险，也未减少孕妇体重增加。婴儿平均出生体重相当。除了5分钟阿氏评分外，其他新生儿结局相似。
对于抑郁的孕妇，持续暴露于SSRI和持续未治疗的抑郁症与超过20%的早产率相关。
