产妇抑郁或抗抑郁药暴露后新生儿和妊娠并发症：一项基于人群的回顾性出生队列研究。

Neonatal and pregnancy complications following maternal depression or antidepressant exposure: A population-based, retrospective birth cohort study.

机构信息

Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Nursing, Chang Gung Institute of Technology, Taoyuan, Taiwan.

Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan; Department of Health Psychology, Chang Jung Christian University, Tainan, Taiwan.

出版信息

Asian J Psychiatr. 2023 Jun;84:103545. doi: 10.1016/j.ajp.2023.103545. Epub 2023 Mar 17.

DOI:10.1016/j.ajp.2023.103545

PMID:37004384

Abstract

OBJECTIVES

Depression is common during pregnancy, and antidepressants are often prescribed for treatment. However, depression and antidepressant use both increase the risk of neonatal and pregnancy complications. To separately evaluate the effects of antidepressant use and the underlying depression on pregnancy and neonatal complications by using a robust statistical method to control for confounding by indication.

METHODS

All study data were obtained from Taiwan's National Health Insurance Research Database. Pregnant women were divided into three groups: those with no depression and no antidepressant exposure(n = 1619,198), depression and no antidepressant exposure(n = 2006), and depression and antidepressant exposure(n = 7857). Antidepressant exposure was further divided into that before pregnancy and during each trimester.

RESULTS

Mothers with depression but no antidepressant exposure exhibited increased risks of intrauterine growth restriction and preterm delivery, compared with mothers without depression. In mothers with depression, antidepressant exposure before pregnancy or during the first trimester conferred increased risks of gestational diabetes mellitus, malpresentation, preterm delivery and cardiovascular anomalies, compared with no antidepressant exposure. Moreover, antidepressant exposure during the second or third trimester conferred increased risks of anemia, a low Apgar score, preterm delivery and genitourinary defects. However, antidepressants administered before pregnancy and during all trimesters did not increase the risk of stillbirth.

CONCLUSION

Depression and antidepressant treatment for depression during pregnancy may individually increase the risks of some neonatal and pregnancy complications. Physicians should thoroughly consider the risks and benefits for both the mother and fetus when treating depression during pregnancy by using antidepressants.

摘要

目的

怀孕期间常见抑郁，常开具抗抑郁药进行治疗。然而，抑郁和使用抗抑郁药均会增加新生儿和妊娠并发症的风险。本研究旨在通过稳健的统计学方法来控制混杂因素，分别评估使用抗抑郁药和潜在抑郁对妊娠和新生儿并发症的影响。

方法

所有研究数据均来自台湾全民健康保险研究数据库。将孕妇分为三组：无抑郁且无抗抑郁药暴露（n=1619198）、抑郁但无抗抑郁药暴露（n=2006）和抑郁且使用抗抑郁药（n=7857）。进一步将抗抑郁药暴露分为妊娠前和每个孕期。

结果

与无抑郁的孕妇相比，有抑郁但未使用抗抑郁药的孕妇发生胎儿宫内生长受限和早产的风险增加。在有抑郁的孕妇中，与无抗抑郁药暴露相比，妊娠前或孕早期使用抗抑郁药会增加妊娠糖尿病、胎位不正、早产和心血管畸形的风险。此外，在孕中期或孕晚期使用抗抑郁药会增加贫血、低 Apgar 评分、早产和泌尿生殖缺陷的风险。然而，妊娠前和所有孕期使用抗抑郁药并未增加死胎的风险。