Abstract：
Selective serotonin-noradrenalin reuptake inhibitors (SNRIs) are used to treat depression and anxiety during pregnancy; however, information regarding their foetal safety is limited. Cohort studies concerning congenital malformations in infants born to mothers exposed to SNRIs during the first trimester of pregnancy were identified. Eight studies were included in the analysis. In general, the use of SNRIs was not associated with an increased risk of overall congenital malformations when compared with no exposure (rate ratio [RR] = 1.07, 95% confidence interval [CI] = 0.94-1.22; P = 0.31), exposure to SSRIs (RR = 1.12, 95% CI = 0.97-1.31; P = 0.12) and no exposure with clinical indication (RR = 1.04, 95% CI = 0.9-1.2; P = 0.564). A significantly increased risk of cardiac malformations was observed (RR = 1.33, 95% CI = 1.15-1.53; P < 0.001); however, this association was not statistically significant when the reference group comprised mothers exposed to SSRIs (RR = 1.1, 95% CI = 0.85-1.43; P = 0.47) or no exposure with clinical indication (RR = 1.17, 95% CI = 0.95-1.42; P = 0.13). The evidence shows no increased risk of congenital malformations and argues against a substantial cardiac teratogenic effect of SNRIs.
摘要：
选择性5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）用于治疗怀孕期间的抑郁和焦虑；然而，有关胎儿安全的信息有限。确定了有关在怀孕的头三个月中暴露于SNRIs的母亲所生的婴儿的先天性畸形的队列研究。分析中包括8项研究。总的来说,与没有暴露相比，使用SNRIs与总体先天性畸形的风险增加无关（比率[RR]=1.07，95％置信区间[CI]=0.94-1.22；P=0.31），暴露于SSRIs（RR=1.12，95％CI=0.97-1.31；P=0.12），无暴露与临床指征（RR=1.04，95％CI=0.9-1.2；P=0.564）。观察到心脏畸形的风险显著增加(RR=1.33,95%CI=1.15-1.53;P<0.001);当参考组包括暴露于SSRIs的母亲(RR=1.1,95%CI=0.85-1.43;P=0.47)或没有暴露于有临床指征的母亲(RR=1.17,95%CI=0.95-1.42;P=0.13)时,这种相关性无统计学意义.证据表明先天性畸形的风险没有增加，并且反对SNRIs的实质性心脏致畸作用。
