Tak Casey R, Job Kathleen M, Schoen-Gentry Katie, Campbell Sarah C, Carroll Patrick, Costantine Maged, Brixner Diana, Birnbaum Angela K, Sherwin Catherine M T
Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
Clinical Trials Office, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Eur J Clin Pharmacol. 2017 Sep;73(9):1055-1069. doi: 10.1007/s00228-017-2269-4. Epub 2017 Jun 9.
Concerns with prescription antidepressant use in pregnant women have instigated the examination of potential associations between fetal exposure to antidepressant medication and outcomes including preterm delivery, congenital malformations, perinatal and post-natal adverse events, persistent pulmonary hypertension, and mortality. The retrospective cohort model is an often utilized study design. The objective of this review is to evaluate the literature on antidepressant use in pregnancy conducted as retrospective cohorts in national/regional medical, or claims databases that assess neonatal and infant outcomes for agreement between studies, ultimately providing a methodological and outcomes summary for future scientific endeavors.
PubMed was searched for literature relating to antidepressant use and infant outcomes from the earliest available date through July 15, 2016. Studies with a retrospective cohort design and conducted in national/regional medical or claims databases were included. Searched outcomes included preterm delivery, congenital malformations, low birth weight, small for gestational age, persistent pulmonary hypertension of the newborn, and other select adverse events comprising low Apgar score (5 min), convulsions/seizures, respiratory distress/problems, fetal mortality, and infant mortality.
Of the 784 studies identified, 36 retrospective cohort studies met eligibility criteria. An increase in preterm delivery and respiratory distress/problems and no increase in congenital malformation or fetal and infant death were associated with prenatal use of prescription antidepressants by majority consensus (at least 2/3 [67%] of studies).
While consensus indicates that perinatal prescription antidepressant use has consequences for the fetus and infant, there are notable inconsistencies in the literature. More investigations that address prenatal exposure to depression and other important covariates are needed.
对孕妇使用处方抗抑郁药的担忧促使人们对胎儿接触抗抑郁药物与早产、先天性畸形、围产期和产后不良事件、持续性肺动脉高压及死亡率等结局之间的潜在关联进行研究。回顾性队列研究模型是一种常用的研究设计。本综述的目的是评估在国家/地区医疗或索赔数据库中作为回顾性队列进行的关于孕期使用抗抑郁药的文献，以评估各项研究在新生儿和婴儿结局方面的一致性，最终为未来的科学研究提供方法学和结局总结。
检索PubMed数据库，查找从最早可获取日期至2016年7月15日期间与抗抑郁药使用和婴儿结局相关的文献。纳入在国家/地区医疗或索赔数据库中进行的回顾性队列研究。检索的结局包括早产、先天性畸形、低出生体重、小于胎龄儿、新生儿持续性肺动脉高压，以及其他选定的不良事件，包括低Apgar评分（5分钟）、惊厥/癫痫发作、呼吸窘迫/问题、胎儿死亡和婴儿死亡。
在检索到的784项研究中，36项回顾性队列研究符合纳入标准。多数研究（至少2/3[67%]的研究）达成共识，孕期使用处方抗抑郁药与早产及呼吸窘迫/问题增加相关，而与先天性畸形或胎儿及婴儿死亡增加无关。
虽然多数研究表明围产期使用处方抗抑郁药对胎儿和婴儿有影响，但文献中仍存在显著的不一致性。需要更多针对产前暴露于抑郁症及其他重要协变量的研究。
