Department of Neuroscience, Psychiatry, Uppsala University, Ing 15 3tr, SE-751 85 Uppsala, Sweden.
BMJ. 2012 Nov 8;345:e7085. doi: 10.1136/bmj.e7085.
To investigate the risks of adverse pregnancy and birth outcomes for treated and untreated bipolar disorder during pregnancy.
Population based cohort study using data from national health registers.
Sweden.
332,137 women with a last menstrual period anytime after 1 July 2005 and giving birth anytime before the end of 31 December 2009. Women with a record of at least two bipolar diagnoses were identified and grouped as treated (n = 320)-those who had filled a prescription for mood stabilisers (lithium, antipsychotics, or anticonvulsants) during pregnancy-or untreated (n = 554). Both groups were compared with all other women giving birth (n = 331,263).
Preterm birth, mode of labour initiation, gestational diabetes, infants born small or large for gestational age, neonatal morbidity, and congenital malformations.
Of the untreated women, 30.9% (n = 171) were induced or had a planned caesarean delivery compared with 20.7% (n = 68,533) without bipolar disorder (odds ratio 1.57, 95% confidence interval 1.30 to 1.90). The corresponding values for the treated women were 37.5% (n = 120) (2.12, 1.68 to 2.67). The risks of preterm birth in both treated and untreated women were increased by 50%. Of the untreated women, 3.9% (n = 542) had a microcephalic infant compared with 2.3% (324,844) of the women without bipolar disorder (1.68, 1.07 to 2.62). The corresponding values for the treated women were 3.3% (n = 311) (1.26, 0.67 to 2.37). Similar trends were observed for risks of infants being small for gestational age infants for weight and length. Among infants of untreated women, 4.3% (n = 24) had neonatal hypoglycaemia compared with 2.5% (n=8302) among infants of women without bipolar disorder (1.51, 1.04 to 2.43), and 3.4% (n = 11) of the treated women (1.18, 0.64 to 2.16). The analyses of variation in outcomes did not support any significant differences between treated and untreated women.
Bipolar disorder in women during pregnancy, whether treated or not, was associated with increased risks of adverse pregnancy outcomes.
探讨治疗和未治疗的妊娠期双相情感障碍的不良妊娠和出生结局风险。
使用国家健康登记数据的基于人群的队列研究。
瑞典。
332137 名末次月经时间在 2005 年 7 月 1 日之后且分娩时间在 2009 年 12 月 31 日之前的女性。记录至少有两次双相诊断的女性被确定为治疗组（n=320），这些女性在怀孕期间开具了心境稳定剂（锂、抗精神病药或抗惊厥药）的处方，或未治疗组（n=554）。将这两组与所有其他分娩的女性（n=331263）进行比较。
早产、分娩方式、妊娠糖尿病、胎儿大小与胎龄不符、新生儿发病率和先天性畸形。
未治疗的女性中，30.9%（n=171）进行了引产或计划剖宫产，而未患双相情感障碍的女性中这一比例为 20.7%（n=68533）（比值比 1.57，95%置信区间 1.30 至 1.90）。治疗组女性的相应值为 37.5%（n=120）（2.12，1.68 至 2.67）。治疗和未治疗的女性早产风险均增加了 50%。未治疗的女性中，3.9%（n=542）的婴儿为小头畸形，而未患双相情感障碍的女性中这一比例为 2.3%（324844）（1.68，1.07 至 2.62）。治疗组女性的相应值为 3.3%（n=311）（1.26，0.67 至 2.37）。对于体重和长度小于胎龄儿的风险，也观察到类似的趋势。在未治疗的女性中，4.3%（n=24）的新生儿患有低血糖，而未患双相情感障碍的女性中这一比例为 2.5%（n=8302）（1.51，1.04 至 2.43），而治疗组女性中 3.4%（n=11）（1.18，0.64 至 2.16）。对结局差异的分析并不支持治疗组和未治疗组之间存在任何显著差异。
无论是否治疗，女性妊娠期的双相情感障碍与不良妊娠结局风险增加相关。
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