Pearson Kimberly H, Nonacs Ruta M, Viguera Adele C, Heller Vicki L, Petrillo Laura F, Brandes Mina, Hennen John, Cohen Lee S
Perinatal and Reproductive Psychiatry Program, Massachusetts General Hospital, Boston, MA 02114, USA.
J Clin Psychiatry. 2007 Aug;68(8):1284-9. doi: 10.4088/jcp.v68n0817.
Antidepressant use during pregnancy and the peripartum period is common despite the absence of clear evidence-based guidelines to direct clinical use of these compounds.
We compared obstetrical and neonatal outcomes as recorded in medical records among 84 pregnant women with major depressive or anxiety disorders (DSM-IV criteria) who took antidepressants during pregnancy (cases) versus a 2:1 age- and parity-matched control group of 168 unexposed women. Women in the case group had sought psychiatric consultation regarding the use of medication from the Perinatal and Reproductive Psychiatry Program at the Massachusetts General Hospital between 1996 and 2000.
There were no significant differences among cases versus controls and their offspring, with respect to various neonatal and obstetrical outcomes, including gestational age and weight, although 1-minute Apgar scores were slightly lower in exposed infants. Admissions to the special care nursery were more frequent, but briefer and based on relatively minor indications, among case newborns. There were no significant differences in neonatal outcomes between exposures to serotonin reuptake inhibitor (SRI) and tricyclic (TCA) antidepressants.
This retrospective cohort study found no evidence of major increases in risk of adverse obstetrical or neonatal outcomes following prenatal exposure to antidepressants, nor between SRIs and TCAs. Larger, prospective studies with specific neurobehavioral measures are required to resolve current uncertainties about safe and effective use of antidepressants by pregnant women.
尽管缺乏明确的循证指南来指导这些化合物在临床上的使用，但孕期和围产期使用抗抑郁药的情况仍很常见。
我们比较了84名患有重度抑郁或焦虑症（符合《精神疾病诊断与统计手册第四版》标准）且在孕期服用抗抑郁药的孕妇（病例组）与168名未暴露的年龄和产次匹配的对照组（比例为2:1）的医疗记录中所记录的产科和新生儿结局。病例组中的女性在1996年至2000年间曾就用药问题向麻省总医院围产期和生殖精神病学项目寻求过精神科咨询。
病例组与对照组及其后代在各种新生儿和产科结局方面，包括胎龄和体重，均无显著差异，尽管暴露婴儿的1分钟阿氏评分略低。病例组新生儿入住特殊护理病房的情况更频繁，但时间较短且基于相对较小的指征。暴露于5-羟色胺再摄取抑制剂（SRI）和三环类（TCA）抗抑郁药的新生儿结局之间无显著差异。
这项回顾性队列研究未发现产前暴露于抗抑郁药后产科或新生儿不良结局风险大幅增加的证据，SRI和TCA之间也无此证据。需要开展更大规模的、采用特定神经行为测量方法的前瞻性研究，以解决目前关于孕妇安全有效使用抗抑郁药的不确定性。
