Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213 Oslo, Norway.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
J Clin Psychiatry. 2019 Jun 18;80(4):18m12572. doi: 10.4088/JCP.18m12572.
To determine the comparative safety of mood stabilizers with respect to risk of preeclampsia, placental abruption, growth restriction, and preterm birth.
A cohort study was carried out using Medicaid Analytic eXtract data for pregnant women linked to live born infants enrolled from 2000 to 2010. Exposure to lamotrigine, valproate, topiramate, carbamazepine, oxcarbazepine, and lithium during the first 20 weeks of pregnancy was assessed. The reference group did not fill a prescription for an anticonvulsant or lithium during the 3 months prior to conception or the first half of pregnancy. Women who continued mood stabilizer monotherapy after 20 weeks were also compared to those who discontinued. Risk ratios (RRs) and 95% CIs were estimated with propensity score stratification to control for confounding.
Among 1,472,672 pregnancies, 10,575 (0.7%) were exposed to anticonvulsant mood stabilizer or lithium monotherapy and 917 (0.06%) were exposed to polytherapy. In unadjusted analyses, exposure to each specific mood stabilizer and polytherapy was associated with increased risks of all adverse outcomes considered compared to no exposure (RR ranged from 1.15 to 1.56). However, these RR estimates were not meaningfully elevated with adjustment for confounding (0.89 to 1.16). Continuation of mood stabilizers was not associated with an increased risk for any outcomes compared to discontinuation and was associated with a reduced risk of placental abruption and growth restriction.
Anticonvulsant mood stabilizers and lithium are not associated with an increased risk of placenta-mediated complications or preterm birth after accounting for confounding by indication.
确定心境稳定剂相对于先兆子痫、胎盘早剥、生长受限和早产风险的相对安全性。
使用医疗补助分析提取数据进行队列研究，将 2000 年至 2010 年期间注册的活产婴儿与孕妇相关联。评估妊娠前 20 周使用拉莫三嗪、丙戊酸、托吡酯、卡马西平、奥卡西平、和锂的情况。参考组在受孕前 3 个月或妊娠前半段未开抗惊厥药或锂的处方。还比较了 20 周后继续使用心境稳定剂单药治疗的女性与停药的女性。采用倾向评分分层来控制混杂因素，估计风险比 (RR) 和 95%置信区间。
在 1,472,672 例妊娠中，有 10,575 (0.7%)例暴露于抗惊厥药心境稳定剂或锂单药治疗，917 (0.06%)例暴露于联合治疗。未经调整的分析中，与无暴露相比，每种特定心境稳定剂和联合治疗的暴露与所有考虑的不良结局风险增加相关（RR 范围为 1.15 至 1.56）。然而，这些 RR 估计值在调整混杂因素后并没有明显升高（0.89 至 1.16）。与停药相比，继续使用心境稳定剂与任何结局的风险增加无关，与胎盘早剥和生长受限的风险降低相关。
在考虑到混杂因素后，抗惊厥药心境稳定剂和锂与胎盘介导的并发症或早产风险增加无关。
