Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
University of California, Berkeley, Berkeley, California, USA.
Pharmacotherapy. 2023 May;43(5):372-380. doi: 10.1002/phar.2790. Epub 2023 Mar 19.
Little is known about antidepressant medication use patterns during pregnancy among periconception (before and immediately following conception) users. Additionally, the associations between these patterns and birth outcomes is unclear, after taking into account underlying depression severity.
This study describes patterns of antidepressant use among periconception users and examines associations between usage patterns and birth outcomes.
This retrospective cohort study included pregnant Kaiser Permanente Northern California (KPNC) members with a live birth between 2014 and 2017 and an antidepressant medication fill that overlapped the 8th week of pregnancy. Outcomes were preterm birth and neonatal intensive care unit (NICU) admission. Data were extracted from KPNC's electronic health records. Modified Poisson regression was conducted.
Of the 3637 pregnancies meeting inclusion criteria, 33% (n = 1204) continued antidepressant use throughout the pregnancy (refilled throughout pregnancy), 47% (n = 1721) discontinued use (no refills), and 20% (n = 712) stopped and reinitiated use (refill after 30+ day gap in supply). Women who continued use had 1.86 (95% confidence interval (CI) 1.53, 2.27) times the risk of preterm birth and 1.76 (95% CI: 1.42, 2.19) times the risk of NICU admission, compared to women who discontinued use during pregnancy. Similarly, women with continued use had 1.66 (95% CI: 1.27, 2.18) times the risk of preterm birth and 1.85 (95% CI: 1.39, 2.46) times the risk of NICU admission, compared to women who stopped and reinitiated use. This relationship held when examining continuous exposure; the relationship between continuous exposure and preterm delivery was stronger in later trimesters.
Periconception antidepressant users who continue use during pregnancy, particularly into the second and third trimesters, may be at higher risk of adverse birth outcomes. This evidence should be considered alongside the risks associated with depression relapse.
对于围孕期（受孕前后）使用抗抑郁药物的患者，我们对抗抑郁药物的使用模式知之甚少。此外，在考虑到潜在抑郁严重程度后，这些使用模式与出生结局之间的关联尚不清楚。
本研究描述了围孕期使用抗抑郁药物的模式，并探讨了使用模式与出生结局之间的关系。
本回顾性队列研究纳入了 2014 年至 2017 年期间在 Kaiser Permanente Northern California（KPNC）分娩的活产孕妇，且在妊娠第 8 周时使用过抗抑郁药物。结局是早产和新生儿重症监护病房（NICU）入住。数据从 KPNC 的电子健康记录中提取。采用校正泊松回归进行分析。
在符合纳入标准的 3637 例妊娠中，33%（n=1204）在整个孕期持续使用抗抑郁药物（整个孕期续药），47%（n=1721）停药（无续药），20%（n=712）停药后重新开始使用（停药 30 天以上续药）。与孕期停药的患者相比，持续用药的患者早产风险增加 1.86 倍（95%置信区间（CI）：1.53，2.27），NICU 入住风险增加 1.76 倍（95%CI：1.42，2.19）。同样，与停药后重新开始用药的患者相比，持续用药的患者早产风险增加 1.66 倍（95%CI：1.27，2.18），NICU 入住风险增加 1.85 倍（95%CI：1.39，2.46）。当检查连续暴露时，这种关系仍然存在；连续暴露与早产之间的关系在后期妊娠中更强。
围孕期使用抗抑郁药物的患者，尤其是在妊娠第二和第三孕期持续使用的患者，可能面临更高的不良出生结局风险。在考虑到与抑郁复发相关的风险后，应考虑这些证据。
