Abstract：
Previous studies examining antidepressants and congenital-malformations were primarily conducted in western countries, and many were constrained by important methodological limitations. This population-based study identified 465,069 women (including 1,705 redeemed ≥1 prescription of antidepressants during first-trimester) aged 15-50 years who delivered their first and singleton child between 2003 and 2018 in a predominantly-Chinese population in Hong Kong, using territory-wide medical-record database of public-healthcare services, and employed propensity-score fine-stratification-weighted logistic-regression analyses to evaluate risk of any major and organ/system-specific congenital-malformations following first-trimester exposure to antidepressants. Major malformation overall was not associated with any antidepressant (weighted-odds-ratio wOR, 0.88 [95 %CI, 0.44-1.76]), specific drug-class, or individual antidepressants. Exposure to any antidepressant was associated with increased risk of cardiac (wOR, 1.82 [95 %CI, 1.07-3.12]) and respiratory anomalies (wOR,4.11 [95 %CI, 1.61-10.45]). Exposure to selective-serotonin-reuptake-inhibitors (SSRI) and multiple-AD-classes were associated with respiratory and cardiac anomalies, respectively. However, these identified associations were not consistently affirmed across sensitivity analyses, precluding firm conclusion. Observed associations of specific cardiac defects with serotonin-norepinephrine-reuptake-inhibitors (SNRI), tricyclic-antidepressants (TCA) and multiple-AD-classes were noted with wide confidence-intervals, suggesting imprecise estimation. Overall, our findings suggest that first-trimester antidepressant exposure was not robustly associated with increased risk of congenital-malformations. Further research clarifying comparative safety of individual antidepressants on specific malformations is warranted.
摘要：
以前检查抗抑郁药和先天性畸形的研究主要在西方国家进行，许多人受到重要的方法论限制。这项基于人群的研究确定了465,069名年龄在15-50岁之间的女性（包括1,705名在妊娠早期赎回≥1种抗抑郁药的处方），他们在2003年至2018年期间在香港以中国为主的人群中分娩了第一个和单胎孩子。使用全港公共医疗服务的医疗记录数据库，并采用倾向评分精细分层加权逻辑回归分析来评估妊娠早期暴露于抗抑郁药后任何重大和器官/系统特异性先天性畸形的风险。总体上严重畸形与任何抗抑郁药无关(加权比值比wOR，0.88[95CI，0.44-1.76])，特定的药物类别，或个体抗抑郁药。暴露于任何抗抑郁药均与心脏病风险增加相关(wOR，1.82[95CI，1.07-3.12])和呼吸异常(wOR，4.11[95CI，1.61-10.45]）。暴露于选择性5-羟色胺再摄取抑制剂（SSRI）和多种AD类别与呼吸和心脏异常有关，分别。然而,这些确定的关联在敏感性分析中没有得到一致的确认，排除坚定的结论。观察到特定心脏缺陷与5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRI）的关联，注意到三环抗抑郁药（TCA）和多个AD类别具有广泛的置信区间，暗示不精确的估计。总的来说,我们的研究结果表明,孕早期抗抑郁药物暴露与先天性畸形的风险增加并无明显相关性.需要进一步的研究来阐明个体抗抑郁药对特定畸形的相对安全性。
