From the Department of Epidemiology, University of Washington.
Departments of Biostatistics.
J Clin Psychopharmacol. 2021;41(4):403-413. doi: 10.1097/JCP.0000000000001410.
The aim of the study was to evaluate the association of antidepressant continuation in pregnancy with infant birth weight among women using antidepressants before pregnancy.
This retrospective cohort study used electronic health data linked with state birth records. We identified singleton live births (2001-2014) to enrolled women with 1 or more antidepressant prescriptions filled 6 months or less before pregnancy, including "continuers" (≥1 antidepressant fills during pregnancy, n = 1775) and "discontinuers" (no fill during pregnancy, n = 1249). We compared birth weight, small or large for gestational age (SGA or LGA), low birth weight (LBW; <2500 g), and macrosomia (>4500 g) between the 2 groups, using inverse probability of treatment weighting to account for pre-pregnancy characteristics, including mental health conditions.
After weighting, infants born to antidepressant continuers weighed 71.9 g less than discontinuers' infants (95% confidence interval [CI], -115.5 to -28.3 g), with a larger difference for female infants (-106.4 g; 95% CI, -164.6 to -48.1) than male infants (-48.5 g; 95% CI, -107.2 to 10.3). For female infants, SGA risk was greater in continuers than discontinuers (relative risk [RR],1.54; 95% CI, 1.02 to 2.32). Low birth weight risk was greater in continuers with 50% or more of days covered (RR, 1.69; 95% CI, 1.11 to 2.58) and exposure in the second trimester (RR, 1.53; 95% CI, 1.02 to 2.29), as compared with discontinuers.
Depending on infant sex, as well as duration and timing of use, continuation of antidepressant use during pregnancy may be associated with lower infant birth weight, with corresponding increases in LBW and SGA.
本研究旨在评估妊娠期间继续使用抗抑郁药与孕妇使用抗抑郁药前婴儿出生体重的关系。
本回顾性队列研究使用电子健康数据与州出生记录相链接。我们确定了 2001-2014 年间单胎活产（enrolled women with 1 or more antidepressant prescriptions filled 6 months or less before pregnancy），包括“继续用药者”（≥1 次妊娠期间抗抑郁药处方，n=1775）和“停药者”（妊娠期间无抗抑郁药处方，n=1249）。我们使用逆概率治疗加权法比较了两组的出生体重、小于胎龄儿（SGA 或 LGA）、低出生体重（LBW；<2500 g）和巨大儿（>4500 g），以考虑包括精神健康状况在内的妊娠前特征。
经加权后，与停药者相比，继续用药者的婴儿出生体重低 71.9 g（95%置信区间[CI]，-115.5 至-28.3 g），女性婴儿的差异更大（-106.4 g；95% CI，-164.6 至-48.1），而男性婴儿的差异较小（-48.5 g；95% CI，-107.2 至 10.3）。与停药者相比，女性继续用药者的 SGA 风险更高（相对风险[RR]，1.54；95% CI，1.02 至 2.32）。与停药者相比，50%或更多天数覆盖（RR，1.69；95% CI，1.11 至 2.58）和暴露于妊娠中期（RR，1.53；95% CI，1.02 至 2.29）的继续用药者的低出生体重风险更高。
根据婴儿性别以及药物使用的持续时间和时间，妊娠期间继续使用抗抑郁药可能与婴儿出生体重较低相关，从而导致低出生体重和 SGA 风险增加。
