Raviv Orian, Lebenthal Yael, Yackobovitch-Gavan Michal, Cohen-Sela Eyal, Almashanu Shlomo, Marom Ronella, Herzlich Jacky, Hiersch Liran, Brener Avivit
Institute of Pediatric Endocrinology, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
BMC Pediatr. 2025 Jan 29;25(1):74. doi: 10.1186/s12887-025-05452-8.
The diagnosis of depression or anxiety treated by SSRIs has become relatively common in women of childbearing age. However, the impact of gestational SSRI treatment on newborn thyroid function is lacking. We explored the impact of gestational SSRI treatment on newborn thyroid function as measured by the National Newborn Screening (NBS) Program and identified contributory factors.
An observational large-scale study of mother-infant dyads of liveborn infants delivered between 2011 and 2022. The Israeli NBS Program thyroid dataset [total thyroxine (TT4) obtained between 36-72 h after delivery] was linked with the electronic medical records of mothers and their infants born at Lis Maternity and Women's Hospital, to generate a unified database. The MDClone big data platform was utilized to extract maternal, perinatal, and neonatal characteristics from the medical records of mother-infant dyads. Only term liveborn infants born to mothers without documented thyroid disease and/or chronic medication administration, except for SSRIs, were included in order to minimize potential confounding effects on the infant's thyroid function. Group stratification relied on the documentation of gestational SSRIs treatment. The variables of interest were maternal, pregnancy, delivery, and perinatal characteristics of the mother-infant dyads. Multivariable forward linear regression model was applied to evaluate explanatory variables for newborn total thyroxine (TT4) levels.
Out of 105,928 infant-mother dyads, 2321(2.2%) mothers had been treated with SSRIs during pregnancy. The SSRI-treated mothers were older (34.8 ± 4.7 vs 32.6 ± 4.8 years, p < 0.001) and had a higher pre-pregnancy body mass index (23.4 ± 4.5 vs 22.7 ± 4.1, p < 0.001), but similar mean weight gain (13 kg) during pregnancy. Cesarean delivery was more common among SSRI-treated mothers than in the general population (p < 0.001). Infants of SSRI-treated mothers had lower WHO-classified birthweight z-scores (-0.25 ± 0.93 vs -0.04 ± 0.92, p < 0.001) and a higher rate of small-for-gestational-age infants (13.4% vs 8.2%, p < 0.001). A multivariable forward linear regression model revealed that SSRI treatment during pregnancy was not a significant contributor to TT4 levels (p = 0.497).
SSRI treatment during pregnancy had no direct effect upon the newborn's adaptation of the hypothalamic-pituitary-thyroidal axis, but several other maternal and delivery characteristics were revealed to possibly impact newborn thyroid function.
在育龄女性中，使用选择性5-羟色胺再摄取抑制剂（SSRI）治疗抑郁症或焦虑症已变得相对普遍。然而，孕期使用SSRI治疗对新生儿甲状腺功能的影响尚不清楚。我们探讨了孕期使用SSRI治疗对通过国家新生儿筛查（NBS）计划测量的新生儿甲状腺功能的影响，并确定了相关因素。
对2011年至2022年间出生的活产母婴进行一项观察性大规模研究。将以色列NBS计划甲状腺数据集[产后36-72小时获得的总甲状腺素（TT4）]与利斯妇产医院出生的母亲及其婴儿的电子病历相关联，以生成一个统一的数据库。利用MDClone大数据平台从母婴二元组病历中提取母亲、围产期和新生儿特征。仅纳入母亲无甲状腺疾病和/或慢性药物治疗记录（SSRI除外）的足月活产婴儿，以尽量减少对婴儿甲状腺功能的潜在混杂影响。组分层依据孕期SSRI治疗的记录。感兴趣的变量是母婴二元组的母亲、妊娠、分娩和围产期特征。应用多变量向前线性回归模型评估新生儿总甲状腺素（TT4）水平的解释变量。
在105,928对母婴二元组中，2321名（2.2%）母亲在孕期接受了SSRI治疗。接受SSRI治疗的母亲年龄较大（34.8±4.7岁 vs 32.6±4.8岁，p<0.001），孕前体重指数较高（23.4±4.5 vs 22.7±4.1，p<0.001），但孕期平均体重增加相似（13kg）。剖宫产在接受SSRI治疗的母亲中比在普通人群中更常见（p<0.001）。接受SSRI治疗的母亲所生婴儿的世界卫生组织分类出生体重z评分较低（-0.25±0.93 vs -0.04±0.92，p<0.001），小于胎龄儿的发生率较高（13.4% vs 8.2%，p<0.001）。多变量向前线性回归模型显示，孕期SSRI治疗对TT4水平不是一个显著的影响因素（p=0.497）。
孕期使用SSRI治疗对新生儿下丘脑-垂体-甲状腺轴的适应性没有直接影响，但其他一些母亲和分娩特征可能会影响新生儿的甲状腺功能。
