Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States.
Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands.
J Affect Disord. 2020 Apr 15;267:57-62. doi: 10.1016/j.jad.2020.02.003. Epub 2020 Feb 3.
While antidepressant use during pregnancy is increasingly common, there is concern about the possible effects of in-utero antidepressant exposure on the child. Our objective was to examine whether there is a dose-effect of maternal serotonin reuptake inhibitors (SRI) during pregnancy on birth outcomes.
Women between 12 and 16 weeks of gestation, who were using an SRI, were eligible for participation in this nation-wide prospective observational cohort study. Recruitment took place between April 2015 and February 2018 (n = 145). SRI exposure and psychopathology symptoms were assessed throughout pregnancy. Exposure was defined as SRI standardized dose at 36 weeks of gestation and mean SRI standardized dose over total pregnancy. Multivariable linear and logistic regression were used to examine the associations with birth weight, gestational age at birth, and being small for gestational age.
Maternal SRI dose at 36 weeks of gestation was significantly associated with birth weight (adjusted ß = -180.7, 95%CI -301.1;-60.2, p-value < 0.01) as was mean SRI standardized dose during total pregnancy (adjusted ß = -187.3, 95%CI -322.0;-52.6, p-value < 0.01). No significant associations between maternal SRI dose and gestational age or being small for gestational age were observed.
Although prospective, we cannot make full causal inferences given that we did not randomize women to different dosages.
These findings suggest that careful dosing of SRI use during pregnancy may prevent a negative impact on birth weight and indicate the need for further investigation of causality.
虽然在怀孕期间使用抗抑郁药越来越常见，但人们仍担心胎儿在子宫内暴露于抗抑郁药可能产生的影响。我们的目的是研究怀孕期间母体选择性 5-羟色胺再摄取抑制剂（SSRIs）的使用剂量是否与出生结局有关。
本全国性前瞻性观察队列研究招募了妊娠 12-16 周且正在使用 SSRIs 的女性。招募时间为 2015 年 4 月至 2018 年 2 月（n=145）。在整个孕期中评估了 SSRIs 的暴露情况和精神病理学症状。暴露情况定义为妊娠 36 周时的 SSRIs 标准化剂量和整个孕期的平均 SSRIs 标准化剂量。多变量线性和逻辑回归用于研究与出生体重、出生时的胎龄和小于胎龄儿的关系。
妊娠 36 周时的母体 SSRIs 剂量与出生体重显著相关（调整后的 β=-180.7，95%CI-301.1；-60.2，p 值<0.01），整个孕期的平均 SSRIs 标准化剂量也与出生体重显著相关（调整后的 β=-187.3，95%CI-322.0；-52.6，p 值<0.01）。未观察到母体 SSRIs 剂量与胎龄或小于胎龄儿之间存在显著相关性。
虽然是前瞻性的，但由于我们没有随机分配女性使用不同剂量，因此我们不能做出完全的因果推断。
这些发现表明，在怀孕期间谨慎调整 SSRIs 的剂量可能有助于预防对出生体重的负面影响，并表明需要进一步研究因果关系。
