Raphael Centre - Perinatal and Infant Mental Health Service, St John of God Health Care, Berwick, Victoria, Australia.
Aust N Z J Psychiatry. 2010 Nov;44(11):978-96. doi: 10.3109/00048674.2010.507543.
Part of three systematic reviews on the effects of psychotropic medication exposure in pregnancy, this paper critically reviews the literature on adverse effects of antidepressant use during pregnancy, and derives recommendations for clinical practice. Electronic databases were searched for original research studies examining the effects of gestational exposure to antidepressants on pregnancy, neonatal and longer-term developmental outcomes. Most results were derived from cohort (prospective and retrospective) and casecontrol studies. There were no randomized controlled trials. Congenital malformations: 35 studies identified, 12 demonstrated a significant association between antidepressant use in early pregnancy and congenital malformations. Pregnancy outcomes: 35 articles identified, outcomes measured rates of spontaneous abortion (4 out of 7 studies reporting elevated risk), preterm birth (15 out of 19 reporting elevated risk) and abnormal birth weight (8 out of 23 reporting elevated risk). Neonatal outcomes: 17 controlled studies including one meta-analysis were identified concerning neonatal adaptation. 15 studies showed an association between gestational exposure to antidepressants and neonatal adaptation difficulties. Three studies examined an association between selective serotonin reuptake inhibitor (SSRI) exposure and persistent pulmonary hypertension in the neonate with conflicting results. Longer-term developmental outcomes: 6 of 7 studies comparing developmental outcomes of children exposed to antidepressants in utero with non- exposed children reported no significant differences. Most of these medications remain relatively safe in pregnancy, but some significant areas of concern exist, particularly some evidence of higher risk of preterm birth, neonatal adaptation difficulties and congenital cardiac malformations (with paroxetine). The impact of these findings on the risk-benefit analysis when treating pregnant women with antidepressants is discussed.
作为三项关于精神药物在孕期暴露影响的系统评价之一，本文批判性地回顾了关于抗抑郁药在孕期使用的不良影响的文献，并为临床实践提供了建议。电子数据库搜索了评估抗抑郁药在妊娠期暴露对妊娠、新生儿和长期发育结果影响的原始研究。大多数结果来自队列（前瞻性和回顾性）和病例对照研究，没有随机对照试验。先天性畸形：确定了 35 项研究，其中 12 项研究表明，早期妊娠使用抗抑郁药与先天性畸形之间存在显著关联。妊娠结局：确定了 35 篇文章，结果测量了自然流产（4 项研究报告风险升高）、早产（19 项研究中有 15 项报告风险升高）和出生体重异常（23 项研究中有 8 项报告风险升高）的发生率。新生儿结局：确定了 17 项包括一项荟萃分析的对照研究，涉及新生儿适应问题。15 项研究表明，妊娠期暴露于抗抑郁药与新生儿适应困难之间存在关联。有 3 项研究检查了抗抑郁药暴露与新生儿持续性肺动脉高压之间的关联，结果存在冲突。长期发育结果：比较宫内暴露于抗抑郁药的儿童与非暴露儿童发育结果的 7 项研究中有 6 项报告无显著差异。这些药物在妊娠期间相对安全，但存在一些值得关注的问题，特别是一些证据表明早产、新生儿适应困难和先天性心脏畸形（与帕罗西汀有关）的风险较高。本文讨论了这些发现对治疗孕妇使用抗抑郁药的风险-效益分析的影响。
