选择性血清素再吸收抑制剂在怀孕期间和死亡出生和婴儿死亡率的风险
Olof Stephansson1, Helle Kieler, Bengt Haglund
1Centre for Pharmacoepidemiology and Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. olof.stephansson@ki.se
JAMA
|January 3, 2013
概括
在一个大规模的北欧研究中,怀孕期间选择性血清素再吸收抑制剂 (SSRI) 的使用与死产或婴儿死亡率没有显著联系. 决策应该考虑母亲的心理健康以及围产期的结果.
科学领域:
- 围产期流行病学 围产期流行病学
- 精神病学药理疗法精神病学药理疗法
背景情况:
- 孕产妇的精神疾病与不良的妊娠结果有关.
- 选择性血清素再吸收抑制剂 (SSRI) 在怀孕期间使用引发了对先天性异常,新生儿戒断和持续性肺高血压的担忧.
- 考虑到母亲的精神病史,SSRI使用与死产或婴儿死亡率之间的关联尚未得到充分证实.
研究的目的:
- 调查与怀孕期间使用SSRI相关的死产和婴儿死亡风险.
- 检查这些风险,同时考虑先前的母亲精神疾病.
主要方法:
- 1996-2007年,北欧国家 (丹麦,芬兰,冰岛,挪威,瑞典) 进行了基于人口的队列研究.
- 数据包括单独分娩,来自注册表的孕产妇SSRI处方,以及来自患者和出生登记表的孕产妇/新生儿结局.
- 使用后勤回归来估计相对风险,并根据母亲的特征和之前的精神病医院住院情况进行调整.
主要成果:
- 这项研究分析了1,633,877例单独分娩,其中29,228名母亲 (1.79%) 在怀孕期间使用SSRI.
- 未经调整的分析显示,SSRI使用者中死胎和产后死亡率较高.
- 多变量模型发现SSRI使用与死产 (aOR,1.17),新生儿死亡 (aOR,1.23) 或新生儿后死亡 (aOR,1.34) 之间没有显著的关联.
- 当通过精神病医院住院史进行分层时,估计进一步减弱,在两组中都没有发现显著的关联.
结论:
- 在一个大规模的北欧队列中,怀孕期间使用SSRI与死产,新生儿死亡率或新生儿后死亡率的风险增加没有显著关联.
- 这些发现表明,SSRI治疗对于这些特定的死亡结果可能是安全的.
- 然而,临床决策必须平衡这些发现与其他围产期风险以及管理母亲精神疾病的好处.
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