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怀孕期间使用抗抑郁药和流产之间的关联:系统性审查和元分析

Sophie Smith¹, Flo Martin², Dheeraj Rai^3,4,5

¹Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Bristol, UK sophie.smith@bristol.ac.uk.

|January 25, 2024

概括

在怀孕期间使用抗抑郁药似乎不会增加流产的风险,当考虑母亲的抑郁症. 由于指示而混,而不是药物本身,可能解释了最初的关联. 这影响了对怀孕期间抗抑郁药安全性的理解.

科学领域:

围产期心理健康研究
生殖流行病学生殖流行病学
怀孕期间的药监督

背景情况:

关于怀孕期间使用抗抑郁药和流产风险的文献存在矛盾.
之前的研究没有充分解决混因素,特别是母亲抑郁症.

研究的目的:

系统地审查和分析关于怀孕期间抗抑郁药物暴露和流产风险的研究.
调查指标混对观察到的关联的影响.

主要方法:

非随机化研究的系统审查和元分析 (病例控制,队列,横截面).
在Medline,Embase和PsychINFO数据库中进行了搜索.
使用随机效应模型进行聚合效应估计;评估偏差风险 (ROBINS-I) 和异质性 (I2).

主要成果:

对29项研究 (5.6万人) 的初步分析表明,使用抗抑郁药物时流产风险更高 (OR 1.24,95% CI 1.18-1.31).
这种关联在与未暴露的患有母性抑郁症的个体相比显著减少 (OR 1.16,95% CI 1.04-1.31).
大多数研究 (22/29) 存在严重偏差风险;只有2项具有中等风险.

结论:

几乎没有证据支持在怀孕期间使用抗抑郁药和在考虑母亲抑郁症后流产之间存在关联.
根据指示混是影响明显关联的重要因素.
研究结果表明,在未来的研究和临床实践中,应该仔细考虑母亲的心理健康状况.

关键词:

抑郁症和情绪障碍抑郁症和情绪障碍流行病学流行病学孕产妇医学孕产妇医学

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