Petersen Irene, Evans Stephen J, Gilbert Ruth, Marston Louise, Nazareth Irwin
Department of Primary Care and Population Health, University College London, Rowland Hill St, London NW3 2PF, United Kingdom
J Clin Psychiatry. 2016 Jan;77(1):e36-42. doi: 10.4088/JCP.14m09241.
Large databases and population registers are increasingly used to examine adverse birth outcomes, congenital heart anomalies, in particular, following antidepressant exposures in pregnancy. Yet many studies have failed to account for other characteristics of the women who were prescribed antidepressants.
To examine the characteristics of women who are prescribed selective serotonin reuptake inhibitors (SSRIs) in pregnancy and women who are not, associations between SSRIs prescribed in pregnancy and congenital heart anomalies, and the association between social and lifestyle characteristics of pregnant women and congenital heart anomalies.
Using data from The Health Improvement Network primary care database in the United Kingdom between January 1, 1990, and January 31, 2011, we set up a comparative study including 4 cohorts of children of women with and without different antidepressant exposures before and during pregnancy. 5,154 women were receiving SSRIs before pregnancy, 2,776 were receiving SSRIs during pregnancy, 992 were receiving other antidepressants during pregnancy, and 200,213 were receiving no antidepressants before or during pregnancy. Our primary outcome was congenital heart anomalies.
Less than 1% of children had a record of congenital heart anomalies within 5 years of birth, and there were no significant differences related to antidepressant exposure in pregnancy (women not prescribed antidepressants versus women prescribed SSRIs in first trimester: odds ratio [OR] = 1.00; 95% CI, 0.65-1.52); however, independent of antidepressant prescribing, diabetes (OR = 2.23; 95% CI, 1.79-2.77), increasing age (OR = 1.01; 95% CI, 1.00-1.02), alcohol problem (OR = 2.58; 95% CI, 1.55-4.29, illicit drug problems (OR = 1.89; 95% CI, 1.09-3.25), and obesity (OR = 1.38; 95% CI, 1.13-1.69) were associated with an increased risk of having a child with congenital heart anomalies.
There was no difference in congenital heart anomalies in children born to women with different antidepressant prescribing exposure status. However, we confirmed an increased risk of congenital heart anomalies in children of older women and in children of women with diabetes, a body mass index above 30 kg/m(2), and a history of alcohol and illicit drug problems independent of the prescription of antidepressants. Future research in this field must account for these characteristics. On the basis of existing evidence, advising women to stop antidepressant treatment in pregnancy may be counterproductive.
大型数据库和人口登记册越来越多地用于研究不良出生结局，尤其是先天性心脏异常与孕期接触抗抑郁药之间的关系。然而，许多研究未能考虑到开具抗抑郁药处方的女性的其他特征。
研究孕期开具选择性5-羟色胺再摄取抑制剂（SSRI）处方的女性和未开具该处方的女性的特征、孕期开具SSRI处方与先天性心脏异常之间的关联，以及孕妇的社会和生活方式特征与先天性心脏异常之间的关联。
利用英国健康改善网络初级保健数据库1990年1月1日至2011年1月31日的数据，我们开展了一项比较研究，纳入了4组队列，这些队列中的儿童来自孕期前后有不同抗抑郁药接触史和无抗抑郁药接触史的女性。5154名女性在孕前接受SSRI治疗，2776名女性在孕期接受SSRI治疗，992名女性在孕期接受其他抗抑郁药治疗，200213名女性在孕前或孕期未接受抗抑郁药治疗。我们的主要结局是先天性心脏异常。
不到1%的儿童在出生后5年内有先天性心脏异常记录，孕期抗抑郁药接触情况与之无显著差异（未开具抗抑郁药处方的女性与孕早期开具SSRI处方的女性相比：优势比[OR]=1.00；95%置信区间，0.65-1.52）；然而，与抗抑郁药处方无关，糖尿病（OR=2.23；95%置信区间，1.79-2.77）、年龄增长（OR=1.01；95%置信区间，1.00-1.02）、酒精问题（OR=2.58；95%置信区间，1.55-4.29）、非法药物问题（OR=1.89；95%置信区间，1.09-3.25）和肥胖（OR=1.38；95%置信区间，1.13-1.69）与生育先天性心脏异常患儿的风险增加相关。
不同抗抑郁药处方接触状态的女性所生孩子的先天性心脏异常情况无差异。然而，我们证实，年龄较大的女性以及患有糖尿病、体重指数高于30kg/m²、有酒精和非法药物问题史的女性所生孩子患先天性心脏异常的风险增加，且与抗抑郁药处方无关。该领域未来的研究必须考虑这些特征。根据现有证据，建议女性在孕期停止抗抑郁药治疗可能会适得其反。
