From the Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks.
J Clin Psychopharmacol. 2021;41(5):571-578. doi: 10.1097/JCP.0000000000001446.
PURPOSE/BACKGROUND: Antidepressants are among the most frequently prescribed medications during pregnancy and may affect fetal weight. Associations between antenatal antidepressant use and ultrasonographic measures of fetal development have rarely been examined. We hypothesized that the prescription of an antenatal antidepressant would be associated with lower estimated fetal weight (EFW).
METHODS/PROCEDURES: A retrospective analysis of routine ultrasonographic data extracted from electronic medical records was performed on a cohort of pregnant women with psychiatric diagnoses and grouped according to the presence of an antenatal antidepressant prescription (n = 32 antidepressant-prescribed and n = 44 antidepressant prescription-free). After stratifying for gestational age, comparisons included 13 ultrasonographic parameters, frequency of oligohydramnios and polyhydramnios and growth deceleration, and maternal serum protein markers assessed per routine care, including α-fetoprotein, free β-human chorionic gonadotropin, and unconjugated estriol levels, using t tests, nonparametric and Fisher tests, and effect sizes (ESs) were computed.
FINDINGS/RESULTS: No statistically significant EFW differences between groups at any time point were detected (P > 0.05). Antenatal antidepressant prescription was associated with lower femur length at weeks 33 to 40 (P = 0.046, ES = 0.75) and greater left ventricular diameter at weeks 25 to 32 (P = 0.04, ES = 1.18). No differences for frequency of oligohydramnios or polyhydramnios or growth deceleration were observed (P > 0.05). We did not detect group differences for maternal proteins (P > 0.05).
IMPLICATIONS/CONCLUSIONS: Our evidence suggested a lack of association between antenatal antidepressant prescription and lower EFW but indicated an association with lower femur length and greater left ventricular diameter in mid-late gestation. Future research should examine the clinical implications of these findings.
目的/背景：抗抑郁药是孕期最常开的药物之一，可能会影响胎儿体重。产前使用抗抑郁药与胎儿发育的超声测量值之间的关联很少被研究。我们假设产前开抗抑郁药与估计胎儿体重（EFW）较低有关。
方法/程序：对有精神科诊断的孕妇的电子病历中的常规超声数据进行回顾性分析，并根据是否有产前开抗抑郁药进行分组（n=32 例抗抑郁药开处方组和 n=44 例无抗抑郁药开处方组）。在对孕龄进行分层后，比较包括 13 个超声参数、羊水过少和羊水过多以及生长减速的频率，以及根据常规护理评估的母体血清蛋白标志物，包括甲胎蛋白、游离β-人绒毛膜促性腺激素和未结合雌三醇水平，使用 t 检验、非参数和 Fisher 检验，并计算效应量（ES）。
结果/发现：在任何时间点，两组的 EFW 均无统计学差异（P＞0.05）。产前开抗抑郁药与 33 至 40 周时的股骨长度较短有关（P=0.046，ES=0.75），与 25 至 32 周时的左心室直径较大有关（P=0.04，ES=1.18）。羊水过少或过多或生长减速的频率无差异（P＞0.05）。我们没有发现母体蛋白的组间差异（P＞0.05）。
我们的证据表明，产前开抗抑郁药与 EFW 降低之间缺乏关联，但表明与中晚期妊娠时的股骨长度较短和左心室直径较大有关。未来的研究应检查这些发现的临床意义。
