Huybrechts Krista F, Sanghani Reesha Shah, Avorn Jerry, Urato Adam C
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee, United States of America.
PLoS One. 2014 Mar 26;9(3):e92778. doi: 10.1371/journal.pone.0092778. eCollection 2014.
Preterm birth is a major contributor to neonatal morbidity and mortality and its rate has been increasing over the past two decades. Antidepressant medication use during pregnancy has also been rising, with rates up to 7.5% in the US. The objective was to systematically review the literature to determine the strength of the available evidence relating to a possible association between antidepressant use during pregnancy and preterm birth.
We conducted a computerized search in PUBMED, MEDLINE and PsycINFO through September 2012, supplemented with a manual search of reference lists, to identify original published research on preterm birth rates in women taking antidepressants during pregnancy. Data were independently extracted by two reviewers, and absolute and relative risks abstracted or calculated. Our a priori design was to group studies by level of confounding adjustment and by timing of antidepressant use during pregnancy; we used random-effects models to calculate summary measures of effect.
Forty-one studies met inclusion criteria. Pooled adjusted odds ratios (95% CI) were 1.53 (1.40-1.66) for antidepressant use at any time and 1.96 (1.62-2.38) for 3rd trimester use. Controlling for a diagnosis of depression did not eliminate the effect. There was no increased risk [1.16 (0.92-1.45)] in studies that identified patients based on 1st trimester exposure. Sensitivity analyses demonstrated unmeasured confounding would have to be strong to account for the observed association.
Published evidence is consistent with an increased risk of preterm birth in women taking antidepressants during the 2nd and 3rd trimesters, although the possibility of residual confounding cannot be completely ruled out.
早产是新生儿发病和死亡的主要原因，在过去二十年中其发生率一直在上升。孕期使用抗抑郁药物的情况也在增加，在美国使用率高达7.5%。目的是系统回顾文献，以确定现有证据的强度，这些证据与孕期使用抗抑郁药物和早产之间可能存在的关联有关。
我们在截至2012年9月的PUBMED、MEDLINE和PsycINFO数据库中进行了计算机检索，并辅以对参考文献列表的手工检索，以识别关于孕期服用抗抑郁药物的女性早产率的原始发表研究。数据由两名审阅者独立提取，并提取或计算绝对风险和相对风险。我们的预先设计是根据混杂因素调整水平和孕期抗抑郁药物使用时间对研究进行分组；我们使用随机效应模型来计算效应的汇总指标。
41项研究符合纳入标准。任何时间使用抗抑郁药物的合并调整优势比（95%可信区间）为1.53（1.40 - 1.66），孕晚期使用为1.96（1.62 - 2.38）。控制抑郁症诊断并不能消除这种效应。在基于孕早期暴露识别患者的研究中，风险没有增加[1.16（0.92 - 1.45）]。敏感性分析表明，未测量的混杂因素必须很强才能解释观察到的关联。
已发表的证据与孕中期和孕晚期服用抗抑郁药物的女性早产风险增加一致，尽管残留混杂的可能性不能完全排除。
