Antidepressant prescriptions, discontinuation, depression and perinatal outcomes, including breastfeeding: A population cohort analysis

ObjectivesTo explore associations between exposure to antidepressants, their discontinuation, depression [medicated or unmediated] and preterm birth [MethodsDesign: A population-based cohort study.Setting: The Secure Anonymised Information Linkage [SAIL] databank in Wales, linking maternal primary care data with infant outcomes.Participants: 107,573, 105,331, and 38,725 infants born 2000–2010 with information on prematurity, SGA and breastfeeding respectively, after exclusions.Exposures: Maternal antidepressant prescriptions in trimesters 2 or 3, discontinuation after trimester 1, recorded diagnosis of depression [medicated or unmediated] in pregnancy.Methods: Odds ratios for adverse pregnancy outcomes were calculated, adjusted for smoking, parity, socio-economic status, and depression.ResultsExclusive formula feeding at 6–8 weeks was associated with prescriptions in trimesters 2 or 3 for any antidepressants (adjusted odds ratio [aOR] 0.81, 95% confidence intervals 0.67–0.98), SSRIs [aOR 0.77, 0.62–0.95], particularly higher doses [aOR 0.45, 0.23–0.86], discontinuation of antidepressants or SSRIs after trimester 1 (aOR 0.70, 0.57–0.83 and 0.66, 0.51–0.87), diagnosis of depression aOR 0.76 [0.70–0.82), particularly if medicated (aOR 0.70, 0.58–0.85), rather than unmedicated (aOR 0.87, 0.82–0.92). Preterm birth at ImplicationsExposure to antidepressants or depression increased risks of exclusive formula feeding at 6–8 weeks, and prescription of antidepressants was associated with SGA rd centile. Prescription of antidepressants offers a useful marker to target additional support and additional care before and during pregnancy and lactation.

研究目标：探索抗抑郁药暴露、抗抑郁药停药情况、伴/不伴药物治疗的抑郁症与早产之间的关联。方法设计：基于人群的队列研究。研究场景：威尔士安全匿名信息链接数据库（Secure Anonymised Information Linkage Databank, SAIL Databank），该数据库关联了孕产妇的初级保健数据与婴儿结局数据。研究对象：经过剔除后，2000-2010年出生的婴儿中，分别有107573例、105331例及38725例纳入对应早产、小于胎龄儿（Small for Gestational Age, SGA）及母乳喂养情况的分析。暴露因素：妊娠第2或3妊娠三月期内的孕产妇抗抑郁药处方情况、妊娠1三月期后抗抑郁药停药情况，以及妊娠期记录的伴/不伴药物治疗的抑郁症诊断。研究方法：计算不良妊娠结局的比值比（Odds Ratio, OR），并校正吸烟情况、产次、社会经济地位及抑郁症因素。研究结果：妊娠6-8周时的完全配方奶喂养与妊娠第2或3三月期内任意抗抑郁药处方（校正比值比（adjusted Odds Ratio, aOR）0.81，95%置信区间（Confidence Interval, CI）0.67~0.98）、选择性5-羟色胺再摄取抑制剂（Selective Serotonin Reuptake Inhibitor, SSRIs）处方（aOR 0.77，95%CI 0.62~0.95），尤其是高剂量SSRIs处方（aOR 0.45，95%CI 0.23~0.86）、妊娠1三月期后抗抑郁药或SSRIs停药情况（aOR分别为0.70、95%CI 0.57~0.83与0.66、95%CI 0.51~0.87）以及抑郁症诊断（aOR 0.76，95%CI 0.70~0.82）显著相关；其中伴药物治疗的抑郁症（aOR 0.70，95%CI 0.58~0.85）的相关性强于不伴药物治疗的抑郁症（aOR 0.87，95%CI 0.82~0.92）。原文此处疑似存在排版缺失：“Preterm birth at”后未完整表述。抗抑郁药暴露或抑郁症诊断会增加妊娠6-8周时完全配方奶喂养的风险，且抗抑郁药处方与小于胎龄儿rd百分位相关。研究意义：抗抑郁药处方可作为一项有用的标志物，用于识别妊娠期及哺乳期需要额外照护与支持的人群。