儿童在子宫内接触抗抑郁药和使用肺部疾病药物。
In utero exposure to antidepressants and the use of drugs for pulmonary diseases in children.
机构信息
Department of Clinical Pharmacy, Isala Klinieken, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands.
出版信息
Eur J Clin Pharmacol. 2013 Mar;69(3):541-7. doi: 10.1007/s00228-012-1314-6. Epub 2012 Jul 20.
PURPOSE
The use of antidepressants during pregnancy is common. Some studies suggest an association between in utero exposure to antidepressants and the occurrence of pulmonary diseases like asthma later in life. Serotonin reuptake inhibitors (SSRIs) as well tricyclic antidepressants (TCAs) are thought to be involved in the development of the respiratory rhythm generator (RRG) and the maturation of the formation of surfactant. In this study the use of drugs for pulmonary diseases in children who were exposed to antidepressants in utero were compared with non-exposed children.
METHODS
The pharmacy prescription database IADB.nl was used for a cohort study in which the use of drugs for pulmonary disease in children after in utero exposure to antidepressants (TCAs, SSRIs) was compared with children with no antidepressant exposure in utero. Drugs for pulmonary diseases were applied as a proxy for disturbed development of the respiratory tract.
RESULTS
A small though significant increase in the incidence risk ratio (IRR) of the use of drugs for pulmonary disease was found after any-time in utero exposure to SSRIs, adjusted for maternal use of antibiotics, of 1.17 (95 % CI 1.16-1.18). An increase was also seen when we looked specifically for the use of SSRIs in at least the first trimester (IRR = 1.18, 95 % CI 1.17-1.20). An increased IRR in the use of drugs for pulmonary disease was also seen when children were exposed to TCAs, but this was not statistically significant. However, in both groups our sample size was rather small. The effect size is modest and may also be confounded by maternal smoking.
CONCLUSIONS
In utero exposure to SSRIs leads to a statistically significant increase in the use of drugs for pulmonary diseases, especially when exposure occurred during the first trimester of pregnancy. The increase in the use of drugs for pulmonary disease may also be related to other factors. Therefore, further study is recommended.
目的
在怀孕期间使用抗抑郁药很常见。一些研究表明，子宫内暴露于抗抑郁药与以后生活中发生哮喘等肺部疾病之间存在关联。人们认为，选择性 5-羟色胺再摄取抑制剂（SSRIs）和三环抗抑郁药（TCAs）参与了呼吸节律发生器（RRG）的发育和表面活性剂形成的成熟。在这项研究中，比较了子宫内暴露于抗抑郁药的儿童与未暴露于抗抑郁药的儿童使用治疗肺部疾病的药物的情况。
方法
使用 IADB.nl 药房处方数据库进行了一项队列研究，其中比较了子宫内暴露于抗抑郁药（TCAs、SSRIs）的儿童与子宫内未暴露于抗抑郁药的儿童使用治疗肺部疾病的药物的情况。使用治疗肺部疾病的药物作为呼吸道发育障碍的替代指标。
结果
调整了母亲使用抗生素后，发现任何时间子宫内暴露于 SSRIs 后，使用治疗肺部疾病的药物的发病率风险比（IRR）略有增加，为 1.17（95%CI 1.16-1.18）。当我们专门观察 SSRIs 在至少第一个三个月的使用情况时，也观察到了增加（IRR=1.18，95%CI 1.17-1.20）。当儿童暴露于 TCAs 时，也观察到了使用治疗肺部疾病的药物的 IRR 增加，但这并不具有统计学意义。然而，在这两个组中，我们的样本量都比较小。效应大小适中，也可能受到母亲吸烟的混杂影响。
结论
子宫内暴露于 SSRIs 会导致使用治疗肺部疾病的药物的数量显著增加，尤其是在妊娠的第一个三个月暴露于 SSRIs 时。使用治疗肺部疾病的药物的增加也可能与其他因素有关。因此，建议进一步研究。
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