怀孕期间同时服用抗抑郁药和苯并二氮杂卓与先天畸形的相关风险:一项基于台湾人口的队列研究。

IF 30.8 1区 医学 Q1 PSYCHIATRY
Lancet Psychiatry Pub Date : 2024-08-01 Epub Date: 2024-07-02 DOI:10.1016/S2215-0366(24)00176-7
Hui-Min Chuang, Lin-Chieh Meng, Chih-Wan Lin, Wen-Wen Chen, Yi-Yung Chen, Chi-Yung Shang, Liang-Kung Chen, Fei-Yuan Hsiao
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引用次数: 0

摘要

背景:尽管抗抑郁药和苯二氮卓类药物经常被同时使用,但孕期同时使用这两种药物与先天性畸形风险之间的关系仍未得到充分探讨。本研究旨在探讨妊娠头三个月同时服用抗抑郁药和苯二氮卓类药物与器官特异性先天畸形之间的关系:我们利用台湾全国出生证明申请数据库、妇幼保健数据库和台湾国民健康保险数据库开展了一项基于人群的队列研究。研究纳入了 2004 年 1 月 1 日至 2018 年 12 月 31 日期间单胎分娩的 15-50 岁孕妇。抗抑郁药和苯二氮卓类药物的使用定义为在怀孕头三个月内至少开过一次处方,同时使用定义为这两种药物的处方期重叠。主要结果为总体先天性畸形和八个器官特异性畸形,包括神经系统、心脏、呼吸系统、口腔裂隙、消化系统、泌尿系统、生殖系统和肢体畸形。采用倾向评分精细分层加权法的逻辑回归模型来控制测量的混杂因素。针对未测量的混杂因素,还进行了控制适应症混杂因素的分析和同胞比较分析。没有有生活经验的个人参与研究或撰写过程:队列中包括 2 634 021 例单胎妊娠,其中 8599 例(0-3%)在妊娠头三个月同时服用抗抑郁药和苯并二氮杂卓(暴露于抗抑郁药和苯并二氮杂卓的妊娠的平均分娩年龄为 31-8 岁 [SD 5-2],未暴露于这两种药物的妊娠的平均分娩年龄为 30-7 岁 [SD 4-9])。所有研究参与者均为女性,有关种族的信息不详。每 100 例接触过抗抑郁药和苯并二氮杂卓的妊娠中畸形的绝对风险为 3-81 例,而未接触过的妊娠中畸形的绝对风险为 2-87 例。倾向得分加权的几率比(加权 OR)并不表明总体畸形(加权 OR 1-10,95% CI 0-94-1-28)、心脏缺陷(1-01,0-83-1-23)或任何其他器官特异性畸形的风险增加,但消化系统畸形除外,其加权 OR 经调整后仍具有统计学意义(1-63,1-06-2-51)。同时使用抗抑郁药和苯二氮卓类药物不会增加总体先天畸形的风险,这一点在控制适应症混杂因素和同胞匹配比较的分析中得到了证实:本研究结果表明,妊娠头三个月同时使用抗抑郁药和苯二氮卓类药物与大多数畸形亚型的风险大幅增加无关。然而,考虑到同时使用这两种药物的其他潜在不良影响,全面评估其风险和益处对于临床决策至关重要:国家科学技术委员会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Concomitant use of antidepressants and benzodiazepines during pregnancy and associated risk of congenital malformations: a population-based cohort study in Taiwan.

Background: Despite the frequent co-administration of antidepressants and benzodiazepines, the association between such concomitant use during pregnancy and the risk of congenital malformations remains inadequately explored. This study aims to examine the association between concomitant use of antidepressants and benzodiazepines during the first trimester and organ-specific congenital malformations.

Methods: We conducted a population-based cohort study using Taiwan's National Birth Certificate Application database, the Maternal and Child Health database, and Taiwan's National Health Insurance database. Pregnant people aged 15-50 years with singleton births between Jan 1, 2004, and Dec 31, 2018, were included. Use of antidepressants and benzodiazepines was defined as at least one prescription during the first trimester, and concomitant use was defined as the overlapping prescription of both drugs with an overlapping prescription period. The primary outcomes were overall congenital malformations and eight organ-specific malformations, consisting of the nervous system, heart, respiratory system, oral cleft, digestive system, urinary system, genital system, and limb malformations. Logistic regression models with propensity score fine stratification weighting approach were used to control for measured confounders. Analyses controlling for confounding by indication and sibling comparison analyses were done to address unmeasured confounders. No individuals with lived experience participated in the research or writing process.

Findings: The cohort included 2 634 021 singleton pregnancies, and 8599 (0·3%) individuals were concomitant users of antidepressants and benzodiazepines during the first trimester (mean age at delivery was 31·8 years [SD 5·2] for pregnancies with exposure to antidepressants and benzodiazepines vs 30·7 years [SD 4·9] for pregnancies without exposure). All study participants were female, and information about ethnicity was not available. Absolute risk of overall malformations was 3·81 per 100 pregnancies with exposure, compared with 2·87 per 100 pregnancies without exposure. The propensity score-weighted odds ratios (weighted ORs) did not suggest an increased risk for overall malformations (weighted OR 1·10, 95% CI 0·94-1·28), heart defects (1·01, 0·83-1·23), or any of the other organ-specific malformations, except for digestive system malformations, for which the weighted OR remained statistically significant after adjustment (1·63, 1·06-2·51). The absence of an increased risk for overall congenital malformations associated with concomitant use of antidepressants and benzodiazepines was supported by the analyses controlling for confounding by indication and sibling-matched comparisons.

Interpretation: The findings of this study suggest that the concomitant use of antidepressants and benzodiazepines during the first trimester is not associated with a substantial increase in risk for most malformation subtypes. However, considering other potential adverse effects of using both medications concomitantly, a thorough assessment of the risks and benefits is crucial for clinical decision making.

Funding: National Science and Technology Council.

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来源期刊
Lancet Psychiatry
Lancet Psychiatry PSYCHIATRY-
CiteScore
58.30
自引率
0.90%
发文量
0
期刊介绍: The Lancet Psychiatry is a globally renowned and trusted resource for groundbreaking research in the field of psychiatry. We specialize in publishing original studies that contribute to transforming and shedding light on important aspects of psychiatric practice. Our comprehensive coverage extends to diverse topics including psychopharmacology, psychotherapy, and psychosocial approaches that address psychiatric disorders throughout the lifespan. We aim to channel innovative treatments and examine the biological research that forms the foundation of such advancements. Our journal also explores novel service delivery methods and promotes fresh perspectives on mental illness, emphasizing the significant contributions of social psychiatry.
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