孕早期使用舍曲林与先天性异常风险：队列研究的系统评价和荟萃分析
Sertraline use in the first trimester and risk of congenital anomalies: a systemic review and meta-analysis of cohort studies.
作者信息
Shen Zi-Qi, Gao Shan-Yan, Li Shawn Xiang, Zhang Tie-Ning, Liu Cai-Xia, Lv Hai-Chen, Zhang Yuan, Gong Ting-Ting, Xu Xin, Ji Chao, Wu Qi-Jun, Li Da
机构信息
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
出版信息
Br J Clin Pharmacol. 2017 Apr;83(4):909-922. doi: 10.1111/bcp.13161. Epub 2016 Dec 4.
AIM
To perform a meta-analysis of available cohort studies on the association between sertraline use by pregnant women in the first trimester and the findings of congenital anomalies in infants.
METHODS
A comprehensive search of articles published from the index date up to 31 December 2015 investigating the aforementioned associations was conducted on PubMed and Web of Science. Mesh headings used included the terms "serotonin reuptake inhibitor," "sertraline," "congenital anomalies" and "obstetrical outcome."
RESULTS
Twelve cohort studies that involved 6 468 241 pregnant women were identified. We summarized odds ratios (ORs) and 95% confidence intervals (CIs) of congenital anomalies using the random-effects model. Pregnant women who used sertraline in the first trimester had a statistically significant increased risk of infant cardiovascular-related malformations (OR = 1.36; 95% CI = 1.06-1.74; I = 64.4%; n = 12) as well as atrial and/or ventricular septal defects (OR = 1.36, 95% CI = 1.06-1.76; I = 62.2%; n = 8). Additionally, positive but nonsignificant associations between sertraline use and congenital anomalies of the nervous system (OR = 1.39; 95% CI = 0.83-2.32; I = 0%; n = 5), digestive system (OR = 1.23; 95% CI = 0.76-1.98; I = 0%; n = 5), eye, ear, face and neck (OR = 1.08; 95% CI = 0.33-3.55; I = 32.1%; n = 3), urogenital system (OR = 1.03; 95% CI = 0.73-1.46; I = 0%; n = 5), and musculoskeletal system (OR = 0.97; 95% CI = 0.69-1.36; I = 0%; n = 5) were observed.
CONCLUSION
This meta-analysis suggested that the use of sertraline use by pregnant women in the first trimester had an increased risk of cardiovascular-related malformations as well as atrial and/or ventricular septal defects in infants. Meanwhile, nonsignificant associations between sertraline use and other congenital anomalies were found. More cohort studies are warranted to provide detailed results of other congenital anomalies.
目的
对关于孕早期孕妇使用舍曲林与婴儿先天性异常结果之间关联的现有队列研究进行荟萃分析。
方法
在PubMed和科学网对从索引日期至2015年12月31日发表的调查上述关联的文章进行全面检索。使用的主题词包括“5-羟色胺再摄取抑制剂”“舍曲林”“先天性异常”和“产科结局”。
结果
确定了12项涉及6468241名孕妇的队列研究。我们使用随机效应模型汇总了先天性异常的比值比（OR）和95%置信区间（CI）。孕早期使用舍曲林的孕妇，其婴儿发生心血管相关畸形的风险在统计学上显著增加（OR = 1.36；95%CI = 1.06 - 1.74；I² = 64.4%；n = 12），以及发生房间隔和/或室间隔缺损的风险也显著增加（OR = 1.36，95%CI = 1.06 - 1.76；I² = 62.2%；n = 8）。此外，观察到舍曲林使用与神经系统先天性异常（OR = 1.39；95%CI = 0.83 - 2.32；I² = 0%；n = 5）、消化系统先天性异常（OR = 1.23；95%CI = 0.76 - 1.98；I² = 0%；n = 5）、眼、耳、面和颈部先天性异常（OR = 1.08；95%CI = 0.33 - 3.55；I² = 32.1%；n = 3）、泌尿生殖系统先天性异常（OR = 1.03；95%CI = 0.
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