Obstetrics and gynecology最新文献_第6页

From Certification to Care: Leveraging American Board of Obstetrics & Gynecology Diplomate and Candidate Data to Address Obstetrician-Gynecologist Workforce Challenges. 从认证到护理：利用美国妇产科委员会的文凭和候选人数据来解决妇产科医生的劳动力挑战。

IF 7.2 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Obstetrics and gynecology

Pub Date : 2026-01-01 DOI: 10.1097/aog.0000000000006148

Amy E Young,Gabriella G Gosman,Kenneth H Kim,George A Macones

引用次数: 0

Comparison of 162 mg and 81 mg Aspirin for Prevention of Preeclampsia: A Randomized Controlled Trial. 162毫克和81毫克阿司匹林预防子痫前期的比较：一项随机对照试验。

IF 4.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Obstetrics and gynecology

Pub Date : 2026-01-01 Epub Date: 2025-10-24 DOI: 10.1097/AOG.0000000000006100

Amrin Khander, Charlene Thomas, Kathy Matthews, Paul Christos, Claire Alcus, Tanvir Alam, Leah Bush, Diksha Deshmukh, Stephen T Chasen, Laura E Riley, Daniel W Skupski, Phyllis August, Line Malha

Objective: To compare the efficacy of 162 mg vs 81 mg aspirin daily for the prevention of preterm preeclampsia (less than 37 weeks of gestation) or preeclampsia with severe features among pregnant people at high risk.

Methods: We conducted a pragmatic, randomized, open-label, blinded endpoint clinical trial. Pregnant people at high risk for preeclampsia were randomized to treatment with either 162 mg or 81 mg aspirin daily beginning before 16 weeks of gestation until term and followed up until 6 weeks postpartum. The primary composite outcome of either preterm preeclampsia or preeclampsia with severe features was adjudicated by independent researchers blinded to treatment group. Secondary outcomes were the components of the composite, adherence to therapy, and maternal and neonatal complications. The anticipated incidence of the primary composite outcome in the 81-mg group was 8.6%. We calculated that enrollment of 394 participants (197 for each group) would have 80% power to detect a 7.1% reduction in the primary outcome with 162 mg aspirin compared with 81 mg, assuming a two-sided α of 0.05.

Results: Of 400 participants randomized, 365 had delivery data available and were included in the intention-to-treat analysis, with 184 participants in the 162-mg group and 181 in the 81-mg group. The incidence of preterm preeclampsia or preeclampsia with severe features was 26 of 184 (14.1%) in the 162-mg group compared with 31 of 181 (17.1%) in the 81-mg group (relative risk 0.83, 95% CI, 0.51-1.33, P =.4). Individual outcomes of preterm preeclampsia and term preeclampsia with severe features were similar between aspirin groups. Adherence rates ranged from 88% to 91% and 89% to 92% for the 162-mg group compared with the 81-mg group, respectively, across study visits. Singleton birth weight was slightly lower in the 162-mg group (2.9 kg vs 3.2 kg, P =.005). There were eight cases of placental abruption in participants randomized to 162 mg compared with 0 in those randomized to 81 mg ( P =.013).

Conclusion: Among people at increased risk for preeclampsia, the rates of preterm preeclampsia or preeclampsia with severe features were similar to rates in those randomized to treatment with either 81 mg or 162 mg aspirin at less than 16 weeks of gestation.

Clinical trial registration: ClinicalTrials.gov , NCT04070573.

目的：比较每日服用162mg阿司匹林与每日服用81mg阿司匹林在高危孕妇中预防早产子痫前期（少于37周）或重度子痫前期的疗效。方法：我们进行了一项实用、随机、开放标签、盲法终点临床试验。高危先兆子痫孕妇被随机分为每日服用162mg或81mg阿司匹林两组，从妊娠16周前开始直至足月，随访至产后6周。早产子痫前期或伴有严重特征的子痫前期的主要综合结局由独立研究人员对治疗组进行盲法判定。次要结局是复合成分、治疗依从性、产妇和新生儿并发症。81 mg组主要综合结局的预期发生率为8.6%。假设双侧α为0.05，我们计算出394名参与者（每组197人）将有80%的能力检测到162 mg阿司匹林与81 mg阿司匹林相比，主要结局减少7.1%。结果：在400名随机参与者中，365名参与者有分娩数据，并被纳入意向治疗分析，其中184名参与者在162毫克组，181名参与者在81毫克组。162 mg组早产子痫前期或伴有严重子痫前期的发生率为26 / 184 (14.1%)，81 mg组为31 / 181(17.1%)（相对危险度0.83,95% CI, 0.51-1.33， P= 0.4）。早产儿子痫前期和重度子痫前期的个体结局在阿司匹林组之间相似。在整个研究访问期间，与81毫克组相比，162毫克组的依从率分别为88%至91%和89%至92%。162 mg组的单胎出生体重略低（2.9 kg vs 3.2 kg， P= 0.005）。在随机分配到162毫克组的参与者中有8例胎盘早剥，而随机分配到81毫克组的参与者中有0例（P= 0.013）。结论：在子痫前期风险增加的人群中，早产子痫前期或具有严重特征的子痫前期的发生率与在妊娠16周以内随机接受81 mg或162 mg阿司匹林治疗的患者的发生率相似。临床试验注册：ClinicalTrials.gov, NCT04070573。

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引用次数: 0

Smartphone Applications to Support Perinatal Mental Health. 支持围产期心理健康的智能手机应用程序

IF 7.2 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Obstetrics and gynecology

Pub Date : 2025-12-18 DOI: 10.1097/aog.0000000000006139

Erin Chang,Adam K Lewkowitz,Jennifer A Unger,Craig F Garfield,Emily S Miller

This narrative review examined the current landscape and evidence base of smartphone applications (apps) designed to support perinatal mental health. Using systematic search methods, we identified apps from the Apple App Store and Google Play Store between April 29 and May 11, 2025, using terms such as "maternal mental health," "perinatal mental health," "postpartum health," and "pregnant mental health." We included apps if they were marketed to perinatal individuals in the United States and aimed to improve mental health outcomes. For each app, we extracted key features (eg, mood tracking, psychoeducation, mindfulness exercises) and cross-referenced PubMed and ClinicalTrials.gov to identify any published or ongoing studies evaluating efficacy, classifying evidence using the U.S. Preventive Services Task Force grading system. Of 587 apps identified, 38 met inclusion criteria, but only three (8%) had peer-reviewed evidence: one with moderate-quality data (Grade B) and two with insufficient evidence (Grade I). Six apps (16%) had ongoing randomized controlled trials to determine efficacy. Collectively, these findings reveal that despite the rapid expansion of perinatal mental health apps, very few have undergone rigorous evaluation. This lack of evidence raises concerns about efficacy, safety, accountability, and value-based care. To ensure safe and effective mental health care delivery, efforts must prioritize the development of evidence-based digital perinatal mental health interventions and apply greater caution in marketing unproven tools directly to patients.

这篇叙述性综述研究了旨在支持围产期心理健康的智能手机应用程序的现状和证据基础。通过系统的搜索方法，我们识别了2025年4月29日至5月11日期间来自苹果应用商店和谷歌Play商店的应用程序，使用了“孕产妇心理健康”、“围产期心理健康”、“产后健康”和“怀孕心理健康”等术语。如果应用程序面向美国的围产期个体销售，并旨在改善心理健康状况，我们就会纳入这些应用程序。对于每个应用程序，我们提取了关键功能（例如情绪跟踪，心理教育，正念练习），并交叉参考PubMed和ClinicalTrials.gov，以确定任何已发表或正在进行的研究评估功效，使用美国预防服务工作组评分系统对证据进行分类。在确定的587个应用程序中，38个符合纳入标准，但只有三个（8%）有同行评审的证据：一个数据质量中等（B级），两个证据不足（I级）。六个应用程序（16%）正在进行随机对照试验以确定疗效。总的来说，这些发现表明，尽管围产期心理健康应用程序迅速扩展，但很少有经过严格评估的应用程序。证据的缺乏引起了人们对疗效、安全性、问责制和基于价值的护理的关注。为确保安全有效地提供精神卫生保健，必须优先考虑开发基于证据的数字围产期精神卫生干预措施，并在直接向患者推销未经证实的工具时更加谨慎。

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引用次数: 0

Endometriosis Surgery: Debates About Restorative Reproductive Medicine. 子宫内膜异位症手术：关于恢复性生殖医学的争论。

IF 7.2 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Obstetrics and gynecology

Pub Date : 2025-12-18 DOI: 10.1097/aog.0000000000006151

Leigh Ann Humphries

For many patients with endometriosis, laparoscopic surgery is the most effective treatment to alleviate severe chronic pelvic pain and improve quality of life. Because endometriosis is common among individuals with infertility, surgery is often considered alongside fertility evaluation and treatment to manage symptoms, identify disease pathology, and restore pelvic anatomy. In patients who desire pregnancy, the decision of whether and when to pursue surgery should be guided by clear medical indications and shared decision making between the patient and their obstetrician-gynecologist. In recent months, however, religious and political groups have sought to reframe this medical decision as an ideologic and moral one, advocating for endometriosis surgery in nearly all patients with infertility and claiming that this can eliminate the need for assisted reproductive technologies. This framework, known as restorative reproductive medicine (RRM), aligns with efforts to promote the "personhood" of fertilized eggs, restrict access to in in vitro fertilization (IVF), and advance endometriosis surgery and lifestyle modifications as "root-cause treatment leading to natural fertility." Recent editorials and issue briefs in the obstetrics and gynecology literature have discussed the serious ethical, medical, and policy implications of RRM, yet there remains an urgent need to address specifically the unfounded claims about endometriosis surgery and its purported advantages over assisted reproductive technology. This article examines the social context of this controversy and reviews the current evidence regarding the indications, benefits, and limitations of endometriosis surgery in the management of infertility. In contrast to RRM's assertions, no evidence supports the adoption of endometriosis surgery as a replacement for IVF or as a primary treatment for infertility. Rather, the role of surgery in fertility care is highly nuanced and depends on each patient's clinical presentation, reproductive goals, and personal priorities.

对于许多子宫内膜异位症患者来说，腹腔镜手术是缓解严重慢性盆腔疼痛和提高生活质量的最有效治疗方法。由于子宫内膜异位症在不孕症患者中很常见，手术通常与生育能力评估和治疗一起考虑，以控制症状、确定疾病病理和恢复骨盆解剖。对于希望怀孕的患者，是否以及何时进行手术的决定应在明确的医学指征和患者与妇产科医生共同决策的指导下进行。然而，最近几个月，宗教和政治团体试图将这一医疗决定重新定义为意识形态和道德的决定，主张对几乎所有不孕症患者进行子宫内膜异位症手术，并声称这可以消除对辅助生殖技术的需求。这一框架被称为恢复性生殖医学（RRM），它与促进受精卵“人格”、限制体外受精（IVF）、推进子宫内膜异位症手术和生活方式改变作为“导致自然生育的根本原因治疗”的努力相一致。最近的产科和妇科文献中的社论和问题摘要讨论了RRM的严重伦理，医学和政策影响，但仍然迫切需要特别解决关于子宫内膜异位症手术的毫无根据的主张及其据称比辅助生殖技术的优势。本文探讨了这一争议的社会背景，并回顾了目前关于子宫内膜异位症手术治疗不孕症的适应症、益处和局限性的证据。与RRM的断言相反，没有证据支持采用子宫内膜异位症手术替代体外受精或作为不孕症的主要治疗方法。相反，手术在生育护理中的作用是非常微妙的，取决于每个患者的临床表现、生育目标和个人优先事项。

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引用次数: 0

Prophylactic-Dose Rivaroxaban Transfer Into Human Milk. 预防剂量的利伐沙班转移到人乳。

IF 7.2 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Obstetrics and gynecology

Pub Date : 2025-12-18 DOI: 10.1097/aog.0000000000006153

Ann M Bruno,Kathleen M Job,Joseph E Rower,Amanda A Allshouse,Erin K Zinkhan,Ming Y Lim,Julie H Shakib,Jerome J Federspiel,Kevin M Watt,Torri D Metz,D Ware Branch

Direct oral anticoagulants are increasingly used for postoperative thromboprophylaxis, but use is limited in postpartum populations in the absence of data informing transfer into human milk. We evaluated the excretion of prophylactic-dose rivaroxaban into the milk of 20 low-risk lactating individuals from April through September 2024. Participants received two doses of prophylactic-dose rivaroxaban and provided blood and milk samples, with rivaroxaban concentrations quantified by liquid chromatography-tandem mass spectrometry. Pharmacokinetic metrics were evaluated, and the relative infant dose was calculated. Maternal plasma and milk rivaroxaban concentration peaked 2 hours after the second dose. At maximum maternal milk concentration of rivaroxaban, the relative infant dose was 2.9%, below the 10% safety threshold for drug use during breastfeeding. Findings suggest that neonatal exposure is likely low risk for use of prophylactic-dose rivaroxaban in lactating individuals.

直接口服抗凝剂越来越多地用于术后血栓预防，但在产后人群中使用有限，因为缺乏数据告知转移到人乳中。从2024年4月至9月，我们评估了20名低风险哺乳期个体将预防剂量的利伐沙班排泄到乳汁中的情况。参与者接受了两剂预防剂量的利伐沙班，并提供了血液和牛奶样本，利伐沙班浓度通过液相色谱-串联质谱测定。评估了药代动力学指标，并计算了相对婴儿剂量。母体血浆和乳汁利伐沙班浓度在第二次给药后2小时达到峰值。在利伐沙班最大母乳浓度下，婴儿相对剂量为2.9%，低于10%的母乳期用药安全阈值。研究结果表明，在哺乳期个体中使用预防剂量的利伐沙班，新生儿暴露的风险可能很低。

引用次数: 0

Association of Prepregnancy Cardiometabolic Markers With Early Childhood Weight in a Study of Hispanic Dyads. 怀孕前心脏代谢标志物与早期儿童体重在西班牙二联体研究中的关系。

IF 7.2 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Obstetrics and gynecology

Pub Date : 2025-12-18 DOI: 10.1097/aog.0000000000006149

Anna Maria Siega-Riz,Catherine J Vladutiu,Christina Cordero,Alan Delamater,Carmen R Isasi,Linda Gallo,Linda Van Horn,Martha L Daviglus,Alison M Stuebe,Madison N LeCroy,Megan L Grove,Heather M Highland,Kari E North,Daniela Sotres-Alvarez

OBJECTIVETo investigate associations between prepregnancy cardiometabolic risk factors and early childhood weight status, independent of genetic susceptibility.METHODSThe ancillary study of the HCHS/SOL (Hispanic Community Health Study/Study of Latinos) included 227 dyads consisting of Hispanic/Latina mothers who had singleton live births between baseline and visit 2 and their children, aged 3-9 years. Child outcomes included body mass index (BMI) z-scores, and weight status categories. Maternal prepregnancy biomarkers included fasting triglycerides, high-density lipoprotein cholesterol (HDL-C), glucose, insulin, blood pressure, BMI, and waist circumference. Child DNA was used to calculate a polygenic risk score for obesity. Linear and logistic regression models adjusted for confounders and child genetic risk.RESULTSOn average, 10.9 years elapsed between maternal baseline assessment and child anthropometry. At baseline, 4.8% of women reported having diabetes or hypertension, one-third had obesity (BMI 30 or higher), and more than half had elevated waist circumference or low HDL-C. Among children (mean age 7.5 years), 17.2% were categorized as having overweight and 27.8% were categorized as having obesity. Higher maternal BMI, larger waist circumference, and higher fasting insulin and diastolic blood pressure were significantly associated with higher child BMI z-scores. A 1-SD increase in maternal BMI (6.1 units) or waist circumference (13.3 cm) was linked to greater odds of child overweight or obesity. Elevated maternal insulin was associated with having a child with overweight status, and higher diastolic blood pressure with having a child in the obesity category in minimally adjusted models.CONCLUSIONPrepregnancy cardiometabolic risk factors in Hispanic/Latina women are associated with higher BMI and obesity risk in their children, independent of genetic predisposition. These findings highlight the prepregnancy period as a critical window for interventions to improve intergenerational health outcomes.

目的探讨独立于遗传易感性的孕前心脏代谢危险因素与儿童早期体重状况的关系。方法HCHS/SOL（西班牙裔社区健康研究/拉丁裔研究）的辅助研究包括227对由基线至第2次访问期间单胎活产的西班牙裔/拉丁裔母亲及其3-9岁的孩子组成的二对。儿童结局包括身体质量指数（BMI） z分数和体重状况类别。孕妇孕前生物标志物包括空腹甘油三酯、高密度脂蛋白胆固醇（HDL-C）、葡萄糖、胰岛素、血压、BMI和腰围。儿童DNA被用来计算肥胖的多基因风险评分。线性和逻辑回归模型调整混杂因素和儿童遗传风险。结果从母体基线评估到儿童人体测量平均间隔10.9年。在基线时，4.8%的女性报告患有糖尿病或高血压，三分之一的女性患有肥胖症（BMI为30或更高），超过一半的女性腰围升高或HDL-C偏低。在儿童（平均7.5岁）中，17.2%被归类为超重，27.8%被归类为肥胖。较高的母亲BMI、较大的腰围、较高的空腹胰岛素和舒张压与较高的儿童BMI z-score显著相关。母亲体重指数（6.1个单位）或腰围（13.3厘米）每增加1个标准差，儿童超重或肥胖的几率就会增加。在最低调整模型中，母亲胰岛素升高与孩子超重有关，舒张压升高与孩子肥胖有关。结论：西班牙裔/拉丁裔妇女孕前心脏代谢危险因素与其子女较高的BMI和肥胖风险相关，与遗传易感性无关。这些发现强调了孕前时期是干预措施改善代际健康结果的关键窗口。

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引用次数: 0

Diagnosis and Management of Euglycemic Diabetic Ketoacidosis in Pregnancy. 妊娠期糖尿病酮症酸中毒的诊断与处理。

IF 7.2 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Obstetrics and gynecology

Pub Date : 2025-12-11 DOI: 10.1097/aog.0000000000006143

John C Rowe,Morgan Scaglione,Marwan Ma'ayeh,George Saade

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus. Euglycemic DKA-a variant of DKA with normal to mildly elevated blood glucose levels (less than 200 mg/dL) that is more common in pregnancy-presents significant diagnostic and treatment challenges. The physiologic adaptations that occur during pregnancy create an environment that makes pregnant patients highly susceptible to euglycemic DKA, with recent data suggesting that up to 35% of DKA cases in pregnancy present with euglycemia. Management cornerstones for euglycemic DKA include aggressive intravenous fluid resuscitation with dextrose-containing fluids, intravenous insulin to halt ketogenesis, and the correction of electrolyte imbalances. Due to the increasing prevalence of diabetes in pregnancy, clinician awareness of euglycemic DKA is crucial, as timely diagnosis and intervention are essential to mitigate adverse maternal and fetal outcomes. In this narrative review, we describe the unique pathophysiology that increases pregnant patients' susceptibility to euglycemic DKA, outline diagnostic intricacies, and detail specific management strategies for this population.

糖尿病酮症酸中毒（DKA）是危及生命的糖尿病并发症。正常血糖型DKA是DKA的一种变体，其血糖水平正常至轻度升高（低于200 mg/dL），在妊娠期更为常见，这给诊断和治疗带来了重大挑战。怀孕期间发生的生理适应创造了一个环境，使怀孕患者极易患血糖正常的DKA，最近的数据表明，高达35%的妊娠DKA病例出现血糖正常。血糖正常DKA的管理基础包括积极的静脉液体复苏，含葡萄糖液体，静脉注射胰岛素以停止生酮，纠正电解质失衡。由于妊娠期糖尿病患病率的增加，临床医生对血糖正常的DKA的认识是至关重要的，因为及时诊断和干预对于减轻孕产妇和胎儿的不良结局至关重要。在这篇叙述性综述中，我们描述了独特的病理生理学，增加了妊娠患者对正糖DKA的易感性，概述了诊断的复杂性，并详细介绍了这一人群的具体管理策略。

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引用次数: 0

Professional Guideline Discrepancies as a Barrier to Labor Progress and Teamwork. 职业指南差异是阻碍劳动进步和团队合作的障碍。

IF 7.2 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Obstetrics and gynecology

Pub Date : 2025-12-11 DOI: 10.1097/aog.0000000000006146

Emily A Donelan,Alexandra Morgan,Jessica Densmore,Kelsey Murray,Molly Hanlon Taub,Mandy Martel,Caitlin Yazel,Joel Bradley,Ella A Damiano

Despite rapidly advancing progress in some areas of pregnancy care, cohesion and interprofessional communication during labor management are dangerously protracted in modern obstetrics. Current discrepancies in national guidelines among professional organizations-specifically the American College of Obstetricians & Gynecologists and the Association of Women's Health, Obstetric and Neonatal Nurses-create conditions for the breakdown of interprofessional teamwork on the labor unit, leading to dystocia both of labor and communication. This article highlights areas of agreement and disagreement between published documents from each professional organization that lead to conflict at the bedside. We propose a purposeful national program of guideline reconciliation in concert with our professional organizations to help bridge these gaps. Finding common ground in current evidence will allow teams to restore trust and ensure collaborative care for patients.

尽管在妊娠护理的某些领域取得了迅速进展，但在现代产科中，分娩管理中的凝聚力和跨专业沟通却被危险地拖延了。目前各专业组织（特别是美国妇产科医师学会和妇女健康、产科和新生儿护士协会）在国家指导方针上的差异，为分娩单位的跨专业团队合作破裂创造了条件，导致分娩和沟通困难。这篇文章强调了每个专业组织发表的文档之间的一致和不一致的领域，这些领域会导致床边的冲突。我们建议与我们的专业组织一起制定一项有目的的国家指导方针和解计划，以帮助弥合这些差距。在现有证据中找到共同点将使团队恢复信任并确保对患者的合作护理。

引用次数: 0

Precancerous Squamous Lesions of the Vulva. 外阴癌前鳞状病变。

IF 7.2 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Obstetrics and gynecology

Pub Date : 2025-12-11 DOI: 10.1097/aog.0000000000006150

Kathryn C Welch,Hope K Haefner,Natalie A Saunders

The rate of vulvar cancer rates is rising, with high-grade squamous intraepithelial lesions, also known as vulvar intraepithelial neoplasia, and differentiated vulvar intraepithelial neoplasia representing key premalignant precursors to vulvar squamous cell carcinoma. Recent advances in classification and understanding of its causes-both human papillomavirus (HPV) associated and HPV independent-have significant implications for the diagnosis and management of these conditions. This review summarizes the evolving terminology, pathogenesis, clinical presentation, and current treatment strategies for vulvar squamous precancers, emphasizing the importance of distinguishing between the two major precancer subtypes to guide appropriate care.

外阴癌的发病率正在上升，高级别鳞状上皮内病变，也称为外阴上皮内瘤变，以及分化的外阴上皮内瘤变是外阴鳞状细胞癌的关键癌前前兆。最近对其病因的分类和了解的进展——包括与人乳头瘤病毒（HPV）相关的和与人乳头瘤病毒无关的——对这些疾病的诊断和治疗具有重要意义。本文综述了外阴鳞状癌前病变的术语、发病机制、临床表现和目前的治疗策略，强调了区分两种主要的癌前病变亚型以指导适当治疗的重要性。

引用次数: 0

Domperidone Use in Lactation and Risk of Severe Postpartum Mental Health Outcomes. 多潘立酮在哺乳期的使用和产后严重心理健康结局的风险

IF 7.2 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Obstetrics and gynecology

Pub Date : 2025-12-11 DOI: 10.1097/aog.0000000000006142

Jonathan Zipursky,Ria Garg,Tianru Wang,Rachela Smith,Ping Li,Simone N Vigod,Tara Gomes,Mina Tadrous

OBJECTIVETo evaluate whether postpartum domperidone use is associated with new-onset psychosis and other severe mental health outcomes.METHODSWe conducted a retrospective cohort study of people who filled a prescription for domperidone within 56 days of delivery between March 1, 2006, and March 1, 2022, in Ontario, Canada. Those who filled a domperidone prescription were matched 1:1 based on propensity score to an equal number of those who did not. The primary outcome was any health care contact for incident psychosis in the subsequent 365 days, with a secondary outcome of any psychiatric emergency department (ED) visit or hospitalization. Cox proportional hazards regression was used to compare outcome risk between people who initiated domperidone and those who did not.RESULTSWe identified 2,237,806 births, and 7,096 (0.3%) were followed by the individuals filling a publicly funded domperidone prescription within 56 days postpartum. After exclusions, 4,629 domperidone-exposed and 116,644 unexposed individuals remained. Overall, 4,585 domperidone-exposed individuals were propensity score matched to an equal number who were unexposed, resulting in good balance across all measured baseline characteristics. Compared with matched postpartum individuals who did not initiate domperidone, domperidone use was not associated with psychosis (6.4/1,000 person-years vs 6.4/1,000 person-years; hazard ratio [HR] 1.00, 95% CI, 0.60-1.67) in the postpartum period. We found no association between domperidone use and ED visits or hospital admissions with mental health diagnoses (38.0/1,000 person-years vs 43.4/1,000 person-years, HR 0.88, 95% CI, 0.71-1.08).CONCLUSIONInitiation of domperidone postpartum was not associated with an increased risk of new-onset psychosis or ED visits or hospital admissions with mental health diagnoses.

目的评价产后使用多潘立酮是否与新发精神病及其他严重心理健康结局相关。方法：我们对2006年3月1日至2022年3月1日期间在加拿大安大略省分娩56天内服用多潘立酮处方的患者进行了回顾性队列研究。根据倾向得分，服用多潘立酮的人与不服用多潘立酮的人的比例为1:1。主要结局是在随后的365天内因突发精神病而进行的任何医疗保健接触，次要结局是任何精神科急诊科（ED）就诊或住院。Cox比例风险回归用于比较使用多潘立酮和未使用多潘立酮的患者之间的结局风险。结果我们确定了2,237,806例分娩，其中7,096例（0.3%）是在产后56天内服用公共资助的多潘立酮处方的个体。排除后，仍有4,629名多潘立酮暴露者和116,644名未暴露者。总体而言，4585名多潘立酮暴露个体的倾向得分与同等数量的未暴露个体相匹配，从而在所有测量的基线特征之间取得了良好的平衡。与未使用多潘立酮的匹配产后个体相比，产后使用多潘立酮与精神病无关（6.4/ 1000人年vs 6.4/ 1000人年；风险比[HR] 1.00, 95% CI, 0.60-1.67）。我们发现多潘立酮使用与ED就诊或住院与精神健康诊断之间没有关联（38.0/ 1000人年vs 43.4/ 1000人年，HR 0.88, 95% CI, 0.71-1.08）。结论产后开始使用多潘立酮与新发精神病、急诊科就诊或因心理健康诊断住院的风险增加无关。

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引用次数: 0