孕期使用抗精神病药物治疗后胎儿死亡的风险。
Risk of Fetal Death after Treatment with Antipsychotic Medications during Pregnancy.
作者信息
Sørensen Merete Juul, Kjaersgaard Maiken Ina Siegismund, Pedersen Henrik Søndergaard, Vestergaard Mogens, Christensen Jacob, Olsen Jørn, Parner Erik, Pedersen Lars Henning, Bech Bodil Hammer
机构信息
Regional Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark.
Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark.
出版信息
PLoS One. 2015 Jul 10;10(7):e0132280. doi: 10.1371/journal.pone.0132280. eCollection 2015.
BACKGROUND
Antipsychotic medications are increasingly used during pregnancy. Nevertheless, fetal risks are still not fully studied. It is currently unclear whether the antipsychotic treatment might induce a higher risk of fetal death. We aimed to determine if use of antipsychotic medication during pregnancy is associated with an increased risk of spontaneous abortion or stillbirth.
METHODS
In a historical cohort study, we identified all clinically recognized pregnancies registered in the nationwide Danish registries from 1997 to 2008 (N = 1,005,319). Exposure was defined as any prescription of antipsychotic medications redeemed by the pregnant women during the exposure window, and recorded in the Danish National Prescription Register. Outcome was defined as any spontaneous abortion or stillbirth recorded in the Danish National Hospital Register and the Danish Medical Birth Register respectively.
RESULTS
Women exposed to antipsychotic medications during pregnancy had a 34% higher risk of spontaneous abortion (adjusted relative risk = 1.34; 95% confidence interval = 1.22; 1.46) compared to unexposed women, but a similar risk compared to women exposed prior to (but not during) pregnancy (adjusted relative risk = 1.04; 95% confidence interval = 0.93; 1.17). The risk of spontaneous abortion was not increased in exposed pregnancies when compared to unexposed pregnancies in the same women (adjusted hazard ratio = 1.11; 95% CI = 0.94; 1.31). A twofold higher risk of stillbirth was found in women exposed to antipsychotic medications compared with unexposed women (relative risk = 2.27; 95% confidence interval = 1.45; 3.55) and compared with women exposed only prior to pregnancy (relative risk = 2.06; 95% confidence interval = 1.01; 4.19).
CONCLUSIONS
The increased risk of spontaneous abortion found in women treated with antipsychotic medications during pregnancy is most likely due to confounding factors. The risk of stillbirth was twofold higher in pregnancies exposed to antipsychotic medication during pregnancy. Treatment with antipsychotic medications during pregnancy requires careful consideration.
背景
抗精神病药物在孕期的使用越来越普遍。然而，胎儿风险仍未得到充分研究。目前尚不清楚抗精神病药物治疗是否会增加胎儿死亡风险。我们旨在确定孕期使用抗精神病药物是否与自然流产或死产风险增加有关。
方法
在一项历史性队列研究中，我们识别了1997年至2008年在丹麦全国登记处登记的所有临床确诊妊娠（N = 1,005,319）。暴露定义为孕妇在暴露窗口期内兑换的任何抗精神病药物处方，并记录在丹麦国家处方登记处。结局分别定义为丹麦国家医院登记处和丹麦医疗出生登记处记录的任何自然流产或死产。
结果
与未暴露的女性相比，孕期暴露于抗精神病药物的女性自然流产风险高34%（调整后相对风险 = 1.34；95%置信区间 = 1.22；1.46），但与孕期前（而非孕期）暴露的女性相比风险相似（调整后相对风险 = 1.04；95%置信区间 = 0.93；1.17）。与同一女性未暴露的妊娠相比，暴露妊娠的自然流产风险并未增加（调整后风险比 = 1.11；95%CI = 0.94；1.31）。与未暴露的女性相比，暴露于抗精神病药物的女性死产风险高出两倍（相对风险 = 2.27；95%置信区间 = 1.45；3.55），与仅在孕期前暴露的女性相比（相对风险 = 2.06；95%置信区间 = 1.01；4.19）。
结论
孕期接受抗精神病药物治疗的女性自然流产风险增加很可能是由于混杂因素。孕期暴露于抗精神病药物的妊娠死产风险高出两倍。孕期使用抗精神病药物治疗需要谨慎考虑。
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