Colvin Lyn, Slack-Smith Linda, Stanley Fiona J, Bower Carol
Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia.
Birth Defects Res A Clin Mol Teratol. 2011 Mar;91(3):142-52. doi: 10.1002/bdra.20773. Epub 2011 Mar 4.
The safety of selective serotonin reuptake inhibitors (SSRIs) during pregnancy remains uncertain. The purpose of this study was to investigate dispensing patterns and pregnancy outcomes for women dispensed an SSRI in pregnancy.
Using data linkage of population-based health datasets from Western Australia and a national pharmaceutical claims dataset, our study included 123,405 pregnancies from 2002 to 2005. There were 3764 children born to 3703 women who were dispensed an SSRI during their pregnancy.
A total of 42.3% of the women were dispensed an SSRI in each trimester, and 97.6% of the women used the same SSRI throughout the first trimester without switching. The women who were dispensed an SSRI were more likely to give birth prematurely (adjusted odds ratio [aOR], 1.4; 95% confidence interval [CI], 1.2-1.7), to have smoked during the pregnancy (OR, 1.9; 95% CI, 1.8-2.1), and parity>1 (OR, 1.7; 95% CI, 1.5-1.8). The singletons were found to have a lower birth weight than expected when other factors were taken into account (OR, 1.2; 95% CI, 1.1-1.3). There was an increased risk of major cardiovascular defects (OR, 1.6; 95% CI, 1.1-2.3). The children of women dispensed citalopram during the first trimester had an increased risk of vesicoureteric reflux (OR, 3.1; 95% CI, 1.3-7.6). Children born to women dispensed sertraline had a higher mean birth weight than those born to women dispensed citalopram, paroxetine, or fluoxetine. This pattern was also seen in birth length.
Most women were dispensed the same SSRI throughout their pregnancy. We have confirmed previous findings with an increased risk of cardiovascular defects and preterm birth. New findings requiring confirmation include an increased risk of vesicoureteric reflux with the use of citalopram.
孕期使用选择性5-羟色胺再摄取抑制剂（SSRI）的安全性仍不确定。本研究旨在调查孕期使用SSRI的女性的配药模式及妊娠结局。
利用西澳大利亚基于人群的健康数据集与国家药品报销数据集的数据链接，我们的研究纳入了2002年至2005年的123,405例妊娠。3703名孕期使用了SSRI的女性共生育了3764名儿童。
共有42.3%的女性在每个孕期都使用了SSRI，97.6%的女性在孕早期全程使用同一种SSRI，未更换。使用SSRI的女性更有可能早产（校正优势比[aOR]为1.4；95%置信区间[CI]为1.2 - 1.7），孕期吸烟（OR为1.9；95% CI为1.8 - 2.1），以及多胎妊娠（OR为1.7；95% CI为1.5 - 1.8）。在考虑其他因素时，发现单胎出生体重低于预期（OR为1.2；95% CI为1.1 - 1.3）。主要心血管缺陷风险增加（OR为1.6；95% CI为1.1 - 2.3）。孕早期使用西酞普兰的女性的孩子发生膀胱输尿管反流的风险增加（OR为3.1；95% CI为1.3 - 7.6）。使用舍曲林的女性所生儿童的平均出生体重高于使用西酞普兰、帕罗西汀或氟西汀的女性所生儿童。出生身长也呈现这种模式。
大多数女性在整个孕期使用同一种SSRI。我们证实了先前关于心血管缺陷和早产风险增加的研究结果。需要进一步证实的新发现包括使用西酞普兰会增加膀胱输尿管反流的风险。
