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

被引:67
作者
Stephansson, Olof [1 ,2 ,3 ]
Kieler, Helle [1 ,2 ]
Haglund, Bengt [1 ,2 ]
Artama, Miia [5 ]
Engeland, Anders [6 ,7 ]
Furu, Kari [6 ,8 ]
Gissler, Mika [4 ,5 ]
Norgaard, Mette [9 ]
Nielsen, Rikke Beck [9 ]
Zoega, Helga [10 ,12 ]
Valdimarsdottir, Unnur [10 ,11 ]
机构
[1] Karolinska Inst, Dept Med Solna, Ctr Pharmacoepidemiol, Stockholm, Sweden
[2] Karolinska Inst, Dept Med Solna, Clin Epidemiol Unit, Stockholm, Sweden
[3] Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden
[4] Nord Sch Publ Hlth, Gothenburg, Sweden
[5] THL Natl Inst Hlth & Welf, Helsinki, Finland
[6] Norwegian Inst Publ Hlth, Dept Pharmacoepidemiol, Div Epidemiol, Oslo, Norway
[7] Univ Bergen, Dept Publ Hlth & Primary Hlth Care, Bergen, Norway
[8] Univ Tromso, Dept Pharm, Tromso, Norway
[9] Aarhus Univ Hosp, Inst Clin Med, Dept Clin Epidemiol, DK-8000 Aarhus, Denmark
[10] Univ Iceland, Sch Hlth Sci, Ctr Publ Hlth Sci, Reykjavik, Iceland
[11] Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA
[12] Mt Sinai Sch Med, Inst Translat Epidemiol, New York, NY USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2013年 / 309卷 / 01期
关键词
PERSISTENT PULMONARY-HYPERTENSION; POPULATION-BASED COHORT; ANTIDEPRESSANT TREATMENT; SPONTANEOUS-ABORTIONS; MAJOR DEPRESSION; NORDIC COUNTRIES; OUTCOMES; PREVALENCE; REGISTERS; NEWBORN;
D O I
10.1001/jama.2012.153812
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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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页码:48 / 54
页数:7
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