Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Pharmacotherapy. 2021 Nov;41(11):907-914. doi: 10.1002/phar.2628. Epub 2021 Oct 26.
To compare associations between individual antidepressants and newborn outcomes.
Retrospective cohort study.
Deliveries in a large, US medical system.
Women who received at least one antidepressant prescription 3 months prior to conception through delivery.
Eligible women had maternal characteristics and newborn outcomes extracted from medical record data. Exposure was defined by the timing of the prescription during pregnancy.
Newborn outcomes (any adaptation syndrome, neonatal intensive care unit (NICU) admission) were analyzed for each antidepressant and compared using standard statistics and multivariable regression compared to exposure to bupropion. Odds of outcomes based on timing of exposure were also explored.
A total of 3,694 women were analyzed. Rates of any adaptation syndrome (p < 0.001), NICU admission (p < 0.001), and transient tachypnea of newborn (TTN) (p = 0.006) were significantly different between drugs. Infants exposed to duloxetine had the highest rates of NICU admissions (39.6%) and adaptation syndromes (15.1%). Venlafaxine-exposed infants had the highest rates of TTN (18.2%). Controlling for maternal age, race, insurance, and gestational age at delivery, early pregnancy antidepressant exposure was associated with adaptation syndrome and NICU admission for both duloxetine (adjusted odds ratio (aOR) 2.31 [95% Confidence Interval (CI) 1.11-4.80] and aOR 2.47 [95% CI 1.40-4.34], respectively) and escitalopram (aOR 1.72 [95% CI 1.09-2.70] and aOR 1.64 [95% CI 1.21-2.22], respectively). Exposure in the third trimester was associated with any adaptation syndrome for citalopram, duloxetine, escitalopram, fluoxetine, sertraline, and venlafaxine and NICU admission for bupropion, citalopram, duloxetine, escitalopram, and fluoxetine.
Duloxetine and escitalopram appear to have the strongest associations with any adaptation syndrome and NICU admission whereas bupropion and sertraline tended to have among the lowest risks of these outcomes. These results can help providers and patients discuss choice of individual antidepressant drugs during pregnancy.
比较个体抗抑郁药与新生儿结局的关联。
回顾性队列研究。
美国大型医疗系统中的分娩。
至少在受孕前 3 个月接受过一次抗抑郁药处方的女性。
从病历数据中提取符合条件的女性的产妇特征和新生儿结局。暴露定义为怀孕期间处方的时间。
每种抗抑郁药的新生儿结局（任何适应综合征、新生儿重症监护病房（NICU）入院）进行分析，并与接受安非他酮的情况进行标准统计学和多变量回归比较。还探讨了基于暴露时间的结局的可能性。
共分析了 3694 名女性。任何适应综合征（p<0.001）、NICU 入院（p<0.001）和新生儿短暂性呼吸急促（TTN）（p=0.006）的发生率在药物之间存在显著差异。接受度洛西汀治疗的婴儿的 NICU 入院率（39.6%）和适应综合征率（15.1%）最高。接受文拉法辛治疗的婴儿 TTN 发生率最高（18.2%）。控制产妇年龄、种族、保险和分娩时的胎龄，孕早期抗抑郁药暴露与度洛西汀（调整后的优势比[aOR]2.31[95%置信区间[CI]1.11-4.80]和 aOR 2.47[95% CI 1.40-4.34]）和依他普仑（aOR 1.72[95% CI 1.09-2.70]和 aOR 1.64[95% CI 1.21-2.22]）相关的适应综合征和 NICU 入院相关。西酞普兰、度洛西汀、依他普仑、氟西汀、舍曲林和文拉法辛的三孕期暴露与任何适应综合征以及布普品、西酞普兰、度洛西汀、依他普仑和氟西汀的 NICU 入院相关。
度洛西汀和依他普仑似乎与任何适应综合征和 NICU 入院的关联最强，而布普品和舍曲林则具有这些结果的最低风险。这些结果可以帮助提供者和患者在怀孕期间讨论个体抗抑郁药物的选择。
