Yonkers Kimberly A., Wisner Katherine L., Stewart Donna E., Oberlander Tim F., Dell Diana L., Stotland Nada, Ramin Susan, Chaudron Linda, Lockwood Charles
Department of Psychiatry, Epidemiology and Public Health, Yale School of Medicine, New Haven, CT 06510, USA
Department of Obstetrics and Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
Obstet Gynecol. 2009 Sep;114(3):703-713. doi: 10.1097/AOG.0b013e3181ba0632.
To address the maternal and neonatal risks of both depression and antidepressant exposure and develop algorithms for periconceptional and antenatal management.
Representatives from the American Psychiatric Association, the American College of Obstetricians and Gynecologists and a consulting developmental pediatrician collaborated to review English language articles on fetal and neonatal outcomes associated with depression and antidepressant treatment during childbearing. Articles were obtained from Medline searches and bibliographies. Search keywords included pregnancy, pregnancy complications, pregnancy outcomes, depressive disorder, depressive disorder/dt, abnormalities/drug-induced/epidemiology, abnormalities/drug-induced/et. Iterative draft manuscripts were reviewed until consensus was achieved.
Both depressive symptoms and antidepressant exposure are associated with fetal growth changes and shorter gestations, but the majority of studies that evaluated antidepressant risks were unable to control for the possible effects of a depressive disorder. Short-term neonatal irritability and neurobehavioral changes are also linked with maternal depression and antidepressant treatment. Several studies report fetal malformations in association with first trimester antidepressant exposure but there is no specific pattern of defects for individual medications or class of agents. The association between paroxetine and cardiac defects is more often found in studies that included all malformations rather than clinically significant malformations. Late gestational use of selective serotonin reuptake inhibitor antidepressants is associated with transitory neonatal signs and a low risk for persistent pulmonary hypertension in the newborn. Psychotherapy alone is an appropriate treatment for some pregnant women; however, others prefer pharmacotherapy or may require pharmacological treatment.
Antidepressant use in pregnancy is well studied, but available research has not yet adequately controlled for other factors that may influence birth outcomes including maternal illness or problematic health behaviors that can adversely affect pregnancy.
探讨抑郁症及抗抑郁药暴露对孕产妇和新生儿的风险，并制定孕前和产前管理算法。
美国精神病学协会、美国妇产科医师学会的代表以及一位咨询发育儿科医生合作，对英文文献中关于生育期间抑郁症及抗抑郁药治疗与胎儿和新生儿结局的文章进行综述。文章通过医学文献数据库检索及参考文献获取。检索关键词包括妊娠、妊娠并发症、妊娠结局、抑郁症、抑郁症/诊断、异常/药物所致/流行病学、异常/药物所致/病因。反复审阅草稿直至达成共识。
抑郁症状和抗抑郁药暴露均与胎儿生长变化及孕周缩短有关，但大多数评估抗抑郁药风险的研究无法控制抑郁症可能产生的影响。新生儿短期易激惹和神经行为改变也与母亲抑郁及抗抑郁药治疗有关。多项研究报告了孕早期抗抑郁药暴露与胎儿畸形有关，但个别药物或药物类别并无特定的缺陷模式。帕罗西汀与心脏缺陷之间的关联在纳入所有畸形而非具有临床意义畸形的研究中更常被发现。妊娠晚期使用选择性5-羟色胺再摄取抑制剂类抗抑郁药与新生儿短暂体征及新生儿持续性肺动脉高压低风险有关。单独心理治疗对一些孕妇是合适的治疗方法；然而，其他孕妇更喜欢药物治疗或可能需要药物治疗。
孕期使用抗抑郁药已得到充分研究，但现有研究尚未充分控制其他可能影响出生结局的因素，包括母亲疾病或可能对妊娠产生不利影响的不良健康行为。
