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首页 » 抑郁症 » JAMA:在怀孕期间服用抗抑郁药物与死产、婴儿死亡风险的增加无关

JAMA:在怀孕期间服用抗抑郁药物与死产、婴儿死亡风险的增加无关

来源:EurekAlert!中文 2013-01-04 22:10

据发表在1月2日刊《美国医学会杂志》上的一则研究披露,一项包括了近3万名北欧国家妇女的研究显示——这些妇女在妊娠期间曾经按照处方获得过一种选择性5 - 羟色胺再摄取抑制剂(SSRI)——在考虑了包括母亲有精神疾病在内的众多因素之后,研究人员表示,妇女在妊娠期间服用这些药物与死产、新生儿死亡或新生儿期之后的死亡风险之间没有发现明显的关系。

根据文章的背景资料:“怀孕时的抑郁症是常见的,在经济发达的国家中,其发生率在7%至19%之间。母亲抑郁症与较差的妊娠结果有关,其中包括早产风险增加,而早产风险增加又转而会造成新生儿的患病和死亡。在怀孕期间服用选择性5 - 羟色胺再摄取抑制剂与新生儿的先天性畸形,新生儿戒断综合征和持续性肺动脉高压有关。然而,在解释先前的母体精神科疾病时,死产和婴儿死亡的风险仍然是未知的。”

瑞典斯德哥尔摩市卡罗林斯卡研究所的Olof Stephansson, M.D., Ph.D.及其同事开展了一项研究,旨在检查在妊娠期间接触SSRI是否与死产、新生儿死亡和新生儿期之后的死亡有关。这项研究包括了在1996至2007年间的不同时期的来自所有北欧国家(丹麦、芬兰、冰岛、挪威和瑞典)的产下单胎的妇女。研究人员从处方登记处获取了产妇使用SSRIs的资讯;从病人处及医疗出生登记处获取了产妇的特征、妊娠及新生儿结果的资讯。文章的作者对与怀孕期间SSRI的使用有关的死产、新生儿死亡及新生儿期之后的死亡的相对风险进行了估计,这一估计考虑了的产妇的特征和产妇先前因精神疾病而住院的因素。

在该研究的163万3877个出生的单胎中,有6054例死产、3609例新生儿死亡及1578例新生儿期之后的死亡事件。共有2万9228位产妇(1.79%)在怀孕期间按处方获得了SSRI。研究人员发现,与那些没有接触过SSRI的妇女相比,那些接触过SSRI的妇女有着较高的死产率(4.62人 vs. 3.69人/每1000人)和新生儿期之后的死亡率 (1.38人 vs. 0.96人/每 1000人)。两组之间的新生儿死亡率相似(2.54人 vs. 2.21人/每1000人)。文章的作者写道:“然而在多变量模型中,SSRI的使用与死产、新生儿死亡或新生儿期之后的死亡无关。当对先前的因精神疾病原因而住院进行分层处理时,估计值会进一步减小。”

“目前的对160万例出生情况所做的研究表明,在怀孕期间使用SSRI与死产、新生儿死亡或新生儿期之后的死亡风险的增加没有关系。在怀孕期间接触过某种SSRI的婴儿中死产和新生儿期之后死亡率的增加可由基础产妇精神疾病的严重性及诸如吸烟和产妇高龄等产妇特征的不利分布来解释。”

研究人员得出结论:“不过,有关在怀孕期间服用SSRIs的决定必须要考虑其它的围产期结果及与产妇的精神疾病有关的风险。”(生物谷Bioon.com)

Selective Serotonin Reuptake Inhibitors During Pregnancy and Risk of Stillbirth and Infant Mortality

Olof Stephansson, MD, PhD; Helle Kieler, MD, PhD; Bengt Haglund, PhD; Miia Artama, PhD; Anders Engeland, PhD; Kari Furu, PhD; Mika Gissler, PhD; Mette Nørgaard, MD, PhD; Rikke Beck Nielsen, MSc; Helga Zoega, PhD; Unnur Valdimarsdóttir, PhD

Importance Maternal psychiatric disease is associated with adverse pregnancy outcomes. Use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy has been associated with congenital anomalies, neonatal withdrawal syndrome, and persistent pulmonary hypertension of the newborn. However, the risk of stillbirth and infant mortality when accounting for previous maternal psychiatric disease remains unknown. Objective To study risk of stillbirth and infant mortality associated with use of SSRIs during pregnancy. Design, Setting, and Participants Population-based cohort study from all Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) at different periods from 1996 through 2007. The study included women with singleton births. We obtained information on maternal use of SSRIs from prescription registries. Maternal characteristics, pregnancy, and neonatal outcomes were obtained from patient and medical birth registries. Main Outcome Measures We used logistic regression to estimate relative risks of stillbirth, neonatal death, and postneonatal death associated with SSRI use during pregnancy taking into account maternal characteristics and previous psychiatric hospitalization. Results Among 1 633 877 singleton births in the study, 6054 were stillbirths; 3609, neonatal deaths; and 1578, postneonatal deaths. A total of 29 228 (1.79%) of mothers had filled a prescription for an SSRI during pregnancy. Women exposed to an SSRI presented with higher rates of stillbirth (4.62 vs 3.69 per 1000, P = .01) and postneonatal death (1.38 vs 0.96 per 1000, P = .03) than those who did not. The rate of neonatal death was similar between groups (2.54 vs 2.21 per 1000, P = .24). Yet in multivariable models, SSRI use was not associated with stillbirth (adjusted odds ratio [OR], 1.17; 95% CI, 0.96-1.41; P = .12), neonatal death (adjusted OR, 1.23; 95% CI, 0.96-1.57; P = .11), or postneonatal death (adjusted OR, 1.34; 95% CI, 0.97-1.86; P = .08). Estimates were further attenuated when stratified by previous hospitalization for psychiatric disease. The adjusted OR for stillbirth in women with a previous hospitalization for psychiatric disease was 0.92 (95% CI, 0.66-1.28; P = .62) and was 1.07 (95% CI, 0.84-1.36; P = .59) for those who had not been previously hospitalized. The corresponding ORs for neonatal death were 0.89 (95% CI, 0.58-1.39; P = .62) for women who were hospitalized and 1.14 (95% CI, 0.84-1.56; P = .39) for women who were not. For postneonatal death, the ORs were 1.02 (95% CI, 0.61-1.69; P = .95) for women who were hospitalized and 1.10 (95% CI, 0.71-1.72; P = .66) for women who were not. Conclusions and Relevance Among women with singleton births in Nordic countries, no significant association was found between use of SSRIs during pregnancy and risk of stillbirth, neonatal mortality, or postneonatal mortality. However, decisions about use of SSRIs during pregnancy must take into account other perinatal outcomes and the risks associated with maternal mental illness.

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