Wartko Paige D, Weiss Noel S, Enquobahrie Daniel A, Chan K C Gary, Stephenson-Famy Alyssa, Mueller Beth A, Dublin Sascha
Department of Epidemiology, University of Washington, Seattle, Washington.
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
Pharmacoepidemiol Drug Saf. 2019 Sep;28(9):1194-1203. doi: 10.1002/pds.4799. Epub 2019 Jul 12.
Previous studies observed modestly higher risk of gestational diabetes (GDM) associated with antidepressant use in pregnancy, potentially due to confounding by indication. We assessed the association of antidepressant continuation in pregnancy with GDM, as well as blood glucose levels, after accounting for confounding.
We conducted a retrospective cohort study of singleton live births from 2001 to 2014 to women enrolled in Kaiser Permanente Washington, an integrated health care delivery system, utilizing electronic health data and linked Washington State birth records. We required that women have ≥1 antidepressant prescription fills ≤6 months before pregnancy. Women with an antidepressant fill during pregnancy were categorized as "continuers" (n = 1634); those without a fill were "discontinuers" (n = 1211). We calculated relative risks (RRs) for GDM and mean differences in screening blood glucose levels using generalized estimating equations with inverse probability of treatment weighting to account for baseline characteristics, including mental health conditions and indicators of mental health severity.
Compared with discontinuers, antidepressant continuers had comparable risk of GDM (RR: 1.10; 95% confidence interval [CI], 0.84-1.44) and blood glucose levels (mean difference: 2.3 mg/dL; 95% CI, -1.5 to 6.1 mg/dL). We observed generally similar results for specific antidepressants, with the potential exceptions of risk of GDM associated with sertraline (RR: 1.30; 95% CI, 0.90-1.88) and venlafaxine (RR: 1.52; 95% CI, 0.87-2.68), but neither association was statistically significant.
Our study suggests that overall, women who continue antidepressants in pregnancy are not at increased risk for GDM or higher blood glucose, although further study may be warranted for sertraline and venlafaxine.
既往研究观察到孕期使用抗抑郁药与妊娠期糖尿病（GDM）风险略有升高相关，这可能是由于指征性混杂因素导致的。在考虑混杂因素后，我们评估了孕期持续使用抗抑郁药与GDM以及血糖水平之间的关联。
我们对2001年至2014年在凯撒永久医疗集团华盛顿分部（一个综合医疗服务系统）登记的单胎活产妇女进行了一项回顾性队列研究，利用电子健康数据和华盛顿州的关联出生记录。我们要求女性在怀孕前≤6个月有≥1次抗抑郁药处方配药记录。孕期有抗抑郁药配药记录的女性被归类为“持续使用者”（n = 1634）；没有配药记录的为“停药者”（n = 1211）。我们使用广义估计方程和治疗权重的逆概率来计算GDM的相对风险（RRs）以及筛查血糖水平的平均差异，以考虑基线特征，包括心理健康状况和心理健康严重程度指标。
与停药者相比，抗抑郁药持续使用者患GDM的风险相当（RR：1.10；95%置信区间[CI]，0.84 - 1.44），血糖水平也相当（平均差异：2.3 mg/dL；95% CI， - 1.5至6.1 mg/dL）。对于特定的抗抑郁药，我们观察到总体结果相似，可能的例外是与舍曲林相关的GDM风险（RR：1.30；95% CI，0.90 - 1.88）和文拉法辛（RR：1.
