Petersen Irene, Sammon Cormac J, McCrea Rachel L, Osborn David P J, Evans Stephen J, Cowen Phillip J, Nazareth Irwin
Department of Primary Care and Population Health, UCL, Rowland Hill St., London NW3 2PF, UK; Department of Clinical Epidemiology, Aarhus University, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark.
Department of Primary Care and Population Health, UCL, Rowland Hill St., London NW3 2PF, UK.
Schizophr Res. 2016 Oct;176(2-3):349-356. doi: 10.1016/j.schres.2016.07.023. Epub 2016 Jul 30.
Limited information is available on whether antipsychotics prescribed in pregnancy are associated with increased risks of adverse outcomes.
We used electronic health records from pregnant women and their children to examine risks of adverse maternal and child outcomes in three cohorts of women who: (A) received antipsychotic treatment in pregnancy (n=416) (B) discontinued antipsychotic treatment before pregnancy (n=670), and (C) had no records of antipsychotic treatment before or during pregnancy (n=318,434). Absolute and risk ratios were estimated and adjusted for health and lifestyle and concomitant medications.
Caesarean section was more common in cohort A (25%) than C (18%), but non-significant after adjustment for health and lifestyle factors (Risk Ratio (adj.) 1.09 (95% CI: 0.92, 1.30). Proportion of gestational diabetes was similar in cohort A (2.6%) and B (2.7%), but lower in A than B after adjustments (RRadj: 0.43 (0.20, 0.93). Premature birth/low birthweight were more common in cohort A (10%) than B (4.3%) and C (3.9%), A versus B (RRadj: 2.04 (1.13, 3.67), A versus C (RRadj: 1.43 (0.99, 2.05). Major congenital malformations were more common in A (3.4%), than B (2.2%) and C (2%). However no significant difference was observed (A versus B: RRadj: 1.79 (0.72, 4.47) A versus C RRadj: 1.59 (0.84, 3.00)). Risks estimates were similar for women prescribed atypical and typical antipsychotics.
Antipsychotic treatment in pregnancy carries limited risks of adverse pregnancy and birth outcomes once adjustments have been made for health and lifestyle factors.
关于孕期使用的抗精神病药物是否会增加不良结局风险的信息有限。
我们利用孕妇及其子女的电子健康记录，在三组女性中研究母婴不良结局的风险，这三组女性分别为：(A)孕期接受抗精神病药物治疗的女性（n = 416）；(B)孕前停用抗精神病药物治疗的女性（n = 670）；(C)孕前及孕期均无抗精神病药物治疗记录的女性（n = 318,434）。估计了绝对风险和风险比，并针对健康、生活方式及伴随用药情况进行了调整。
剖宫产在A组（25%）比C组（18%）更常见，但在对健康和生活方式因素进行调整后无显著差异（调整后的风险比1.09（95%可信区间：0.92, 1.30））。A组（2.6%）和B组（2.7%）的妊娠期糖尿病比例相似，但调整后A组低于B组（调整后的风险比：0.43（0.20, 0.93））。早产/低出生体重在A组（10%）比B组（4.3%）和C组（3.9%）更常见，A组与B组相比（调整后的风险比：2.04（1.13, 3.67）），A组与C组相比（调整后的风险比：1.43（0.99, 2.05））。严重先天性畸形在A组（3.4%）比B组（2.2%）和C组（2%）更常见。然而未观察到显著差异（A组与B组相比：调整后的风险比：1.79（0.72, 4.47）；A组与C组相比：调整后的风险比：1.59（0.84, 3.00））。使用非典型和典型抗精神病药物的女性风险估计相似。
一旦对健康和生活方式因素进行调整，孕期使用抗精神病药物带来的不良妊娠和分娩结局风险有限。
