Trixler Mátyás, Gáti Agnes, Fekete Sándor, Tényi Tamás
Department of Psychiatry, University Medical School of Pécs, Pécs, Hungary.
Drugs. 2005;65(9):1193-206. doi: 10.2165/00003495-200565090-00002.
The rapid development of pharmacotherapy has resulted in a growing clinical importance for the treatment of the increasing number of women with schizophrenia during pregnancy. An evolving database on reproductive health safety factors for women with schizophrenia has begun to be of assistance in optimising clinical benefits for women with childbearing potential. Given the prevalence of antipsychotic use during pregnancy in women with schizophrenia, it is important for the clinician to have a prepared approach to the administration of these agents. In general, the use of psychotropic medication during pregnancy is indicated when risk to the fetus from exposure to this medication is outweighed by the risks of untreated psychiatric illness in the mother. The preponderance of evidence from registries to large health surveys indicate that treatment with antipsychotic medication confers either no or a small nonspecific risk for organ malformations. According to the relevant literature published on the safety of antipsychotic medication during pregnancy, the findings are encouraging; however, the currently available data are very limited. Until there are more controlled prospective data on the impact of drugs on fetal and later development, the clinician will continue to work in a state of potential uncertainty, weighing partially estimated risks against managing individual clinical problems. The aim for the clinician should be to provide the best information available regarding the scope of possible risks associated with the treatment of schizophrenia during pregnancy. On the basis of the available data, generalisation is impossible and recommendations should be made on a drug-by-drug basis. The risks and benefits must always be carefully weighed for each patient on an individual basis. Only a woman who is well enough to acknowledge her pregnancy and her mental illness can effectively weigh the relative and partially unknown risks of treatment with antipsychotic medication against the highly probable risks of illness exacerbation if untreated.
药物治疗的快速发展使得在孕期治疗越来越多患精神分裂症的女性在临床上变得愈发重要。一个不断发展的关于精神分裂症女性生殖健康安全因素的数据库已开始有助于为有生育潜力的女性优化临床益处。鉴于精神分裂症女性孕期使用抗精神病药物的普遍性，临床医生对这些药物的给药采用一种有准备的方法很重要。一般来说，当母亲未经治疗的精神疾病风险超过胎儿接触此药物的风险时，孕期使用精神类药物是合理的。从登记处到大型健康调查的大量证据表明，使用抗精神病药物治疗对器官畸形要么没有风险，要么只有很小的非特异性风险。根据已发表的关于孕期抗精神病药物安全性的相关文献，研究结果令人鼓舞；然而，目前可获得的数据非常有限。在有更多关于药物对胎儿及后续发育影响的对照前瞻性数据之前，临床医生将继续在潜在的不确定性状态下工作，权衡部分估计的风险与处理个体临床问题。临床医生的目标应该是提供关于孕期治疗精神分裂症可能存在的风险范围的最佳可用信息。基于现有数据，无法进行概括，应逐药做出推荐。必须始终根据每个患者的个体情况仔细权衡风险和益处。只有身体状况良好、能够知晓自己怀孕及患有精神疾病的女性，才能有效地权衡使用抗精神病药物治疗的相对且部分未知的风险与如果不治疗疾病恶化的极有可能的风险。
