孕期使用抗抑郁药与分娩结局：对英国、挪威和瑞典电子健康数据的分析。
Antidepressant use during pregnancy and birth outcomes: analysis of electronic health data from the UK, Norway, and Sweden.
作者信息
Martin Florence Z, Ahlqvist Viktor H, Madley-Dowd Paul, Lundberg Michael, Cohen Jacqueline M, Furu Kari, Rai Dheeraj, Forbes Harriet, Easey Kayleigh, Håberg Siri E, Sharp Gemma C, Magnusson Cecilia, Magnus Maria C
机构信息
MRC Integrative Epidemiology Unit, Oakfield House, University of Bristol, BS8 2BN Florence Z Martin PhD student Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000 Aarhus, Denmark Viktor H Ahlqvist postdoctoral fellow MRC Integrative Epidemiology Unit, University of Bristol, BS8 2BN Paul Madley-Dowd research fellow Solnavägen 1 E, 11365 Stockholm Michael Lundberg statistician Marcus Thranes gate 6, 0473 Oslo Jacqueline M Cohen senior researcher Marcus Thranes gate 6, 0473 Oslo Kari Furu research professor Centre for Academic Mental Health, Canynge Hall, University of Bristol, BS8 2PN Dheeraj Rai professor of neurodevelopmental psychiatry Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT Harriet Forbes assistant professor School of Psychological Science, University of Bristol, BS8 1TU Kayleigh E Easey senior lecturer Myrens verksted 2, 0473 Oslo Siri E Håberg centre director School of Psychology, University of Exeter, EX4 4QG Gemma C Sharp associate professor of epidemiology Solnavägen 1 E, 11365 Stockholm Cecilia Magnusson adjunct professor Myrens verksted 2, 0473 Oslo Maria C Magnus researcher.
出版信息
medRxiv. 2024 Oct 30:2024.10.30.24316340. doi: 10.1101/2024.10.30.24316340.
OBJECTIVES
To explore the association between antidepressant use during pregnancy and birth outcomes.
DESIGN
Cohort study.
SETTING
Electronic health record data.
PARTICIPANTS
2 528 916 singleton births from the UK's Clinical Practice Research Datalink (1996-2018), Norway's Medical Birth Registry (2009-2020), and Sweden's Medical Birth Register (2006-2020).
MAIN OUTCOME MEASURES
Stillbirth, neonatal death, pre- and post-term delivery, small and large for gestational age, and low Apgar score five minutes post-delivery.
RESULTS
A total of 120 209 (4.8%) deliveries were exposed to maternal antidepressant use during pregnancy. Maternal antidepressant use during pregnancy was associated with increased odds of stillbirth (adjusted pooled OR (aOR) 1.16, 95% CI 1.05 to 1.28), preterm delivery (aOR 1.26, 95% CI 1.23 to 1.30), and Apgar score < 7 at 5 minutes (aOR 1.83, 95% CI 1.75 to 1.91). These findings persisted in the discordant sibling analysis, but with higher uncertainty. The adjusted predicted absolute risk for stillbirth was 0.34% (95% CI 0.33 to 0.35) among the unexposed and 0.40% (95% CI 0.36 to 0.44) in the antidepressant exposed. Restricting to women with depression or anxiety, the association between antidepressant exposure and stillbirth attenuated (aOR 1.07, 95% CI 0.94 to 1.21). Paternal antidepressant use was modestly associated with preterm delivery and low Apgar score. Most antidepressants were associated with preterm delivery (except paroxetine) and Apgar score (except mirtazapine and amitriptyline).
CONCLUSIONS
Maternal antidepressant use during pregnancy may increase the risk of stillbirth, preterm delivery, and low Apgar score, although the absolute risks remained low. Confounding by severity of indication cannot be ruled out, as the severity of symptoms was not available. The modest association between paternal antidepressant use and both preterm delivery and low Apgar score suggests that residual confounding by familial environment cannot be ruled out.
目的
探讨孕期使用抗抑郁药与分娩结局之间的关联。
设计
队列研究。
背景
电子健康记录数据。
参与者
来自英国临床实践研究数据链（1996 - 2018年）、挪威医疗出生登记处（2009 - 2020年）以及瑞典医疗出生登记册（2006 - 2020年）的2528916例单胎分娩。
主要结局指标
死产、新生儿死亡、早产和足月产、小于胎龄儿和大于胎龄儿，以及出生后5分钟阿氏评分低。
结果
共有120209例（4.8%）分娩的孕妇在孕期使用了抗抑郁药。孕期母亲使用抗抑郁药与死产几率增加相关（调整后的合并比值比[aOR]为1.16，95%置信区间[CI]为1.05至1.28）、早产（aOR为1.26，95%CI为1.23至1.30）以及出生后5分钟阿氏评分<7（aOR为1.83，95%CI为1.75至1.91）。这些发现在线性同胞分析中仍然存在，但不确定性更高。未暴露组死产的调整后预测绝对风险为0.34%（95%CI为0.33至0.35），抗抑郁药暴露组为0.40%（95%CI为0.36至0.44）。将研究限制在患有抑郁症或焦虑症的女性中，抗抑郁药暴露与死产之间的关联减弱（aOR为1.07，95%CI为0.94至1.21）。父亲使用抗抑郁药与早产和阿氏评分低有适度关联。大多数抗抑郁药与早产（除帕罗西汀外）和阿氏评分（除米氮平和阿米替林外）相关。
结论
孕期母亲使用抗抑郁药可能会增加死产、早产和阿氏评分低的风险，尽管绝对风险仍然较低。由于症状严重程度不可得，不能排除因适应症严重程度导致的混杂因素。父亲使用抗抑郁药与早产和阿氏评分低之间的适度关联表明，不能排除家庭环境导致的残余混杂因素。
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