Background

Pregnant women who suffer from depressive disorders are likely to be treated with antidepressant (AD) medications. Recent meta-analyses underlined the possible relation between AD use and several neonatal outcomes, although the underlying mechanisms remains unclear.

Methods

To summarise and evaluate the associations between AD use in pregnancy and neonatal outcomes, we conducted an umbrella review of meta-analyses of observational studies published up to December 2019 in PubMed and Embase. Summary risk estimates for the associations between use of AD as a whole, or specific AD classes and drugs, and the risk of neonatal outcomes were reported.

Results

Our review included 22 meta-analyses investigating 69 associations. However, none were supported by convincing evidence. Highly suggestive evidence regarded the associations between (i) any time AD exposure and the risk of preterm birth (relative risk, 1.68; 95% confidence interval 1.52, 1.86), (ii) any time exposure to selective serotonin reuptake inhibitors (SSRIs) and the risk of preterm birth (1.43; 1.22, 1.37) and (iii) respiratory distress (1.33; 1.14, 1.55), and (iv) SSRI exposure during the first trimester of pregnancy and the risk of cardiovascular malformations (1.25; 1.13, 1.39). Suggestive evidence was obtained for any time AD exposure on 1-min low Apgar score (absolute average difference, −0.34; −0.53, −0.14).

Conclusions

Overall, the effects of AD exposure during pregnancy on neonatal outcomes have been extensively studied, but few of the associations are graded as high quality evidence. More prospective studies and large collaborations with comprehensive standardised reporting of analyses are needed.

中文翻译：

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妊娠和新生儿结局中抗抑郁药的使用：观察性研究的荟萃分析综述

背景

患有抑郁症的孕妇可能会接受抗抑郁药治疗。尽管尚不清楚其基本机制，但最近的荟萃分析强调了AD使用与若干新生儿结局之间的可能关系。

方法

为了总结和评估孕妇使用AD与新生儿结局之间的关联，我们对截至2019年12月在PubMed和Embase上发表的观察性研究进行了荟萃分析。报告了有关整体使用AD或特定AD类别和药物与新生儿结局风险之间的关联的风险汇总估算。

结果

我们的审查包括22项荟萃分析，调查了69个协会。但是，没有任何证据令人信服。极具启发性的证据考虑到（i）任何时间暴露于AD与早产风险之间的关联（相对风险，1.68； 95％置信区间1.52，1.86），（ii）任何时间暴露于选择性5-羟色胺再摄取抑制剂（SSRIs）和早产的风险（1.43; 1.22，1.37）和（iii）呼吸窘迫（1.33; 1.14，1.55），以及（iv）怀孕前三个月的SSRI暴露风险和心血管畸形的风险（1.25; 1.13，1.39） ）。在低至1分钟的Apgar评分（绝对平均差，-0.34； -0.53，-0.14）下，AD暴露的任何时间均获得了暗示性证据。

结论

总体而言，已经广泛研究了怀孕期间AD暴露对新生儿结局的影响，但是很少有关联被评为高质量证据。需要进行更多的前瞻性研究，并需要进行大型合作以及对分析进行全面标准化的报告。