第一季度抗抑郁药的使用和流产:临床实践研究数据链接GOLD的综合分析
Florence Zoe Martin1, Paul C Madley-Dowd2, Viktor H Ahlqvist3
1University of Bristol Medical School, MRC Integrative Epidemiology Unit flo.martin@bristol.ac.uk.
概括
在怀孕早期使用抗抑郁药物显示出较小,临床上无意义的流产风险增加. 与未暴露妊娠相比,在妊娠前和第一季度持续使用不会增加流产风险.
科学领域:
- 产科和妇科 产科和妇科
- 精神病学是一个精神病学.
- 药学流行病学 药学流行病学
背景情况:
- 怀孕期间抗抑郁药的处方正在增加.
- 关于在怀孕期间使用抗抑郁药物的安全性仍然存在不确定性.
- 关于抗抑郁药的使用和流产风险的现有证据是可变的.
研究的目的:
- 调查第一季度抗抑郁药使用与流产之间的关联.
- 量化绝对和调整后的流产风险与怀孕早期抗抑郁药物暴露的关系.
主要方法:
- 使用英国临床实践研究数据链接 (CPRD) 黄金数据 (1996-2018) 的基于人口的队列研究.
- 确定的怀孕与抗抑郁药物处方重叠的第一季度 ("暴露") 与未暴露的怀孕.
- 使用考克斯模型计算调整的危险比率 (aHR) 和绝对风险,控制混因素.
主要成果:
- 分析了超过100万例怀孕;7.2%的孕妇在第一季度接触过抗抑郁药.
- 调整后的分析显示,在第一季度使用抗抑郁药时,流产风险略有增加 (aHR为1.04).
- 绝对调整后的流产风险为暴露妊娠的13.6%,而未暴露妊娠的13.1%.
- 在服用抗抑郁药物的女性中,在怀孕前和第一季度内没有观察到流产风险增加 (aHR 1.00).
结论:
- 第一个三个月的抗抑郁药使用与流产风险的小,临床上无意义的增加有关.
- 没有证据表明,在怀孕前和第一季度使用抗抑郁药物会增加流产风险.
- 这些发现有助于了解怀孕早期抗抑郁药的安全性.
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