Department of Epidemiology, University of Washington, Seattle, Washington.
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
Am J Perinatol. 2021 Nov;38(13):1442-1452. doi: 10.1055/s-0040-1713652. Epub 2020 Jun 30.
Both excessive and inadequate gestational weight gain (GWG) are associated with adverse health outcomes for the woman and her child. Antidepressant use in pregnancy could affect GWG, based on evidence in nonpregnant women that some antidepressants may cause weight gain and others weight loss. Previous studies of antidepressant use and GWG were small with limited ability to account for confounding, including by maternal mental health status and severity. We assessed the association of antidepressant continuation in pregnancy with GWG among women using antidepressants before pregnancy.
Our retrospective cohort study included singleton livebirths from 2001 to 2014 within Kaiser Permanente Washington, an integrated health care system. Data were obtained from electronic health records and linked Washington State birth records. Among women with ≥1 antidepressant fill within 6 months before pregnancy, women who filled an antidepressant during pregnancy were considered "continuers;" women without a fill were "discontinuers." We calculated mean differences in GWG and relative risks (RR) of inadequate and excessive weight gain based on Institute of Medicine guidelines. Using inverse probability of treatment weighting with generalized estimating equations, we addressed differences in maternal characteristics, including mental health conditions.
Among the 2,887 births, 1,689 (59%) were to women who continued antidepressants in pregnancy and 1,198 (42%) were to discontinuers. After accounting for confounding, continuers had similar weight gain to those who discontinued (mean difference: 1.3 lbs, 95% confidence interval [CI]: -0.1 to 2.8 lbs) and similar risks of inadequate and excessive GWG (RR: 0.95, 95% CI: 0.80-1.14 and RR: 1.06, 95% CI: 0.98-1.14, respectively). Findings were comparable for specific antidepressants and trimesters of exposure.
We did not find evidence that continuation of antidepressants in pregnancy led to differences in GWG.
· Antidepressant use is associated with weight change in nonpregnant populations.. · Prior evidence on whether antidepressant use in pregnancy affects gestational weight gain is sparse.. · We accounted for confounding by characteristics such as mental health conditions and their severity.. · We found no association between pregnancy antidepressant continuation and gestational weight gain..
无论是过度还是不足的妊娠体重增加（GWG）都与妇女及其子女的健康不良结局有关。基于非孕妇中某些抗抑郁药可能导致体重增加而另一些抗抑郁药可能导致体重减轻的证据，妊娠期间使用抗抑郁药可能会影响 GWG。以前关于抗抑郁药使用和 GWG 的研究规模较小，无法充分考虑混杂因素，包括孕产妇心理健康状况和严重程度。我们评估了妊娠期间继续使用抗抑郁药与妊娠前使用抗抑郁药的妇女 GWG 之间的关系。
我们的回顾性队列研究包括 2001 年至 2014 年期间在 Kaiser Permanente Washington（一个综合医疗保健系统）的单胎活产。数据来自电子健康记录并与华盛顿州出生记录相关联。在妊娠前 6 个月内至少有一次抗抑郁药处方的女性中，在妊娠期间开具抗抑郁药的女性被认为是“继续者”；没有处方的女性为“中断者”。我们根据医学研究所的指南计算了 GWG 的平均差异和体重不足和超重增加的相对风险（RR）。使用广义估计方程的逆概率治疗加权，我们解决了孕产妇特征（包括心理健康状况）方面的差异。
在 2887 例分娩中，1689 例（59%）为妊娠期间继续使用抗抑郁药的女性所生，1198 例（42%）为中断者所生。在考虑混杂因素后，继续者的体重增加与中断者相似（平均差异：1.3 磅，95%置信区间[CI]：-0.1 至 2.8 磅），并且 GWG 不足和过多的风险相似（RR：0.95，95%CI：0.80-1.14 和 RR：1.06，95%CI：0.98-1.14）。在特定抗抑郁药和暴露的妊娠期间，结果均相似。
我们没有发现妊娠期间继续使用抗抑郁药会导致 GWG 差异的证据。
·抗抑郁药的使用与非孕妇群体重变化有关。·关于妊娠期间使用抗抑郁药是否影响妊娠体重增加的证据很少。·我们考虑了混杂因素，如心理健康状况及其严重程度。·我们发现妊娠期间继续使用抗抑郁药与妊娠体重增加之间没有关联。
