Knudsen Tanja Majbrit, Hansen Anne Vinkel, Garne Ester, Andersen Anne-Marie Nybo
Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen K, Denmark.
BMC Pregnancy Childbirth. 2014 Sep 25;14:333. doi: 10.1186/1471-2393-14-333.
Previous studies suggest a possible association between maternal use of selective serotonin-reuptake inhibitors (SSRIs) during early pregnancy and congenital heart defects (CHD). The purpose of this study was to verify this association by using validated data from the Danish EUROCAT Register, and secondary, to investigate whether the risk differs between various socioeconomic groups.
We conducted a cohort study based on Danish administrative register data linked with the Danish EUROCAT Register, which includes all CHD diagnosed in live births, fetal deaths and in pregnancies terminated due to congenital anomalies. The study population consisted of all registered pregnancies (n = 72,280) in Funen, Denmark in the period 1995-2008. SSRI-use was assessed using The Danish National Prescription Registry, information on marital status, maternal educational level, income, and country of origin from Statistics Denmark was used as indicators of socioeconomic situation, and the CHD were studied in subgroups defined by EUROCAT. Logistic Regression was used to investigate the association between redeemed prescriptions for SSRIs and CHD.
The risk of severe CHD in the offspring of the 845 pregnant women who used SSRIs during first trimester increased four times (AOR 4.03 (95% CI 1.75-9.26)). We found no increased risk of septal defects. Socioeconomic position did not modify the association between maternal SSRI-use during pregnancy and severe CHD.
This study, which is based on data with high case ascertainment, suggests that maternal use of SSRIs during first trimester increases the risk of severe CHD, but does not support findings from previous studies, based on administrative register data, regarding an increased risk of septal defects. The study was unable to document an interaction between socioeconomic status and maternal SSRI-use on the risk of severe CHD.
先前的研究表明，孕期早期母亲使用选择性5-羟色胺再摄取抑制剂（SSRI）与先天性心脏缺陷（CHD）之间可能存在关联。本研究的目的是通过使用丹麦EUROCAT登记处的有效数据来验证这种关联，其次，调查不同社会经济群体之间的风险是否存在差异。
我们基于与丹麦EUROCAT登记处相关联的丹麦行政登记数据进行了一项队列研究，该登记处包括所有活产、死胎以及因先天性异常而终止妊娠中诊断出的CHD。研究人群包括1995年至2008年期间丹麦菲英岛所有登记的妊娠（n = 72,280）。使用丹麦国家处方登记处评估SSRI的使用情况，丹麦统计局提供的婚姻状况、母亲教育水平、收入和原籍国信息用作社会经济状况指标，并在EUROCAT定义的亚组中研究CHD。使用逻辑回归研究SSRI的已兑现处方与CHD之间的关联。
在孕早期使用SSRI的845名孕妇的后代中，患严重CHD的风险增加了四倍（比值比4.03（95%可信区间1.75 - 9.26））。我们未发现间隔缺损风险增加。社会经济地位并未改变孕期母亲使用SSRI与严重CHD之间的关联。
这项基于高病例确诊率数据的研究表明，孕早期母亲使用SSRI会增加患严重CHD的风险，但不支持先前基于行政登记数据的研究结果，即关于间隔缺损风险增加的研究结果。该研究无法证明社会经济地位与母亲使用SSRI对严重CHD风险的相互作用。
