Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.
JAMA Netw Open. 2024 Oct 1;7(10):e2438269. doi: 10.1001/jamanetworkopen.2024.38269.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are consistently reported to be discontinued by approximately half of pregnant women. Little is known about how this may be associated with postpartum psychiatric health.
To investigate associations of SSRI or SNRI discontinuation in pregnant women with depression or anxiety and psychiatric health and sick leave absence after childbirth.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study was conducted between 2006 and 2019 using data from Swedish population-based registers. Pregnant women with a filled prescription of an SSRI or SNRI in the 90 days before pregnancy without recorded comorbid or severe psychiatric conditions were included. Analyses were performed in November 2023.
K-means for longitudinal data was used to cluster trajectories of SSRI and SNRI use during pregnancy, resulting in 2 trajectory groups based on the number of days covered, defined as continued and discontinued use groups.
The primary outcome was psychiatric-related hospitalizations by 90 days after childbirth. Secondary outcomes included psychiatric-related outpatient visits, self-harm and suicide, and any-cause mortality by 90 days after childbirth and all outcomes plus sick leave absence by 1.5 years after childbirth.
Among 27 773 pregnant women (17 241 aged ≥30 years [62.1%] at childbirth), 13 184 women (47.5%) had discontinued SSRI or SNRI use and 14 589 individuals (52.5%) had continued use. Individuals in the discontinued compared with continued use group were younger (5588 women [42.4%] vs 4944 women [33.9%] aged <30 years), less educated (4281 women [32.5%] vs 5821 women [39.9%] who completed postsecondary education or above), and more likely to have smoked in early pregnancy (1445 individuals [11.0%] vs 1180 individuals [8.1%]), been born in a non-Nordic country (1641 individuals [12.4%] vs 975 individuals [6.7%]), and used anxiolytics (1301 individuals [9.9%] vs 1119 individuals [7.7%]) and hypnotics and sedatives (1609 individuals [12.2%] vs 1510 individuals [10.4%]). Psychiatric-related hospitalizations occurred in 49 individuals (0.4%) in the discontinued vs 59 individuals (0.5%) in the continued use group in the 90 days after childbirth, with an adjusted hazard ratio (aHR) of 1.28 (95% CI, 0.85-1.91), while at 1.5 years after childbirth, the aHR was 0.81 (95% CI, 0.66-1.00). Lower hazard rates for psychiatric-related outpatient visits in the discontinued vs continued use group at 90 days (aHR, 0.59; 95% CI, 0.53-0.66) and 1.5 years (aHR, 0.60; 95% CI, 0.57-0.64) after childbirth were found. No difference in sick leave absence was found; however, individuals who discontinued had fewer days of sick leave by 1.5 years after childbirth than those who continued (mean [SD], 44.6 [70.6] days vs 53.1 [82.3] days).
In this study, approximately half of pregnant women discontinued SSRIs or SNRIs, and discontinuation during pregnancy was not associated with adverse psychiatric-related outcomes, including hospitalizations, outpatient visits, suicidal behavior, or sick leave absence in the 90 days or 1.5 years after childbirth.
选择性 5-羟色胺再摄取抑制剂（SSRIs）和 5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）被一致报告约有一半的孕妇停止使用。对于这可能如何与产后精神健康相关，我们知之甚少。
研究孕妇停止使用 SSRIs 或 SNRIs 与产后抑郁或焦虑以及精神健康和病假缺勤之间的关系。
设计、设置和参与者：这项基于人群的队列研究于 2006 年至 2019 年期间使用瑞典基于人群的登记处的数据进行。纳入了在怀孕前 90 天内开具了 SSRIs 或 SNRIs 处方但没有记录合并症或严重精神疾病的孕妇。分析于 2023 年 11 月进行。
使用纵向数据的 K-均值聚类方法对怀孕期间 SSRIs 和 SNRIs 使用的轨迹进行聚类，根据覆盖的天数将其分为继续使用和停止使用两组，定义为继续使用组和停止使用组。
主要结果是产后 90 天内的精神科相关住院情况。次要结果包括产后 90 天内的精神科相关门诊就诊、自残和自杀，以及产后 90 天内的任何原因死亡率以及产后 1.5 年的所有结果加上病假缺勤。
在 27773 名孕妇（17241 名年龄≥30 岁[62.1%]的分娩）中，13184 名女性（47.5%）停止使用 SSRIs 或 SNRIs，而 14589 名个体（52.5%）继续使用。与继续使用组相比，停止使用组的个体年龄更小（5588 名女性[42.4%]与 4944 名女性[33.9%]年龄<30 岁），教育程度更低（4281 名女性[32.5%]与 5821 名女性[39.9%]完成中学后教育或以上），并且更有可能在孕早期吸烟（1445 名个体[11.0%]与 1180 名个体[8.1%]）、出生在非北欧国家（1641 名个体[12.4%]与 975 名个体[6.7%]）、使用抗焦虑药物（1301 名个体[9.9%]与 1119 名个体[7.7%]）和催眠镇静剂（1609 名个体[12.2%]与 1510 名个体[10.4%]）。产后 90 天内，停止使用组有 49 名（0.4%）个体发生精神科相关住院治疗，而继续使用组有 59 名（0.5%）个体发生该情况，调整后的危险比（aHR）为 1.28（95%CI，0.85-1.91），而在产后 1.5 年时，aHR 为 0.81（95%CI，0.66-1.00）。在产后 90 天（aHR，0.59；95%CI，0.53-0.66）和 1.5 年（aHR，0.60；95%CI，0.57-0.64）时，停止使用组的精神科相关门诊就诊次数的危险率较低。在产后 90 天或 1.5 年时，病假缺勤情况无差异；然而，与继续使用的个体相比，停止使用的个体在产后 1.5 年时的病假天数较少（平均[标准差]，44.6[70.6]天与 53.1[82.3]天）。
在这项研究中，大约一半的孕妇停止使用 SSRIs 或 SNRIs，怀孕期间的停药与产后 90 天或 1.5 年内的不良精神科相关结局（包括住院、门诊就诊、自杀行为或病假缺勤）无关。
