Department of Mental Health, ASL Salerno, Italy.
Curr Opin Psychiatry. 2011 Jan;24(1):34-40. doi: 10.1097/YCO.0b013e3283413451.
During the last few years, several researches, often showing contradictory findings, have investigated the safety of psychotropic medications used for treating mood disorders in pregnancy. Hence, the necessity exists to update this information constantly in order to ensure the safest option for the mother-infant pair.
The risk of fetal anomalies associated with early in-utero exposure to antidepressants seems to be increased after paroxetine and clorimipramine exposure, whereas prenatal exposure to nearly all antidepressants is linked to the potential onset of the Prenatal Antidepressant Exposure Syndrome. As regards classic mood stabilizers, the teratogenic risk historically reported with lithium should probably be softened, whereas valproate is the medication which shows the strongest association with fetal anomalies. An increased risk of autism-spectrum disorders and infant neurodevelopmental delay is also associated with valproate exposure through the placenta. No significant reproductive safety data are available on atypical antipsychotics, although such medications may indirectly increase the rate of fetal malformation by inducing gestational diabetes.
Avoiding the use of clorimipramine, paroxetine, valproate, and atypical antipsychotics during pregnancy is advisable. However, when starting or continuing pharmacological treatment during pregnancy, clinicians should consider not only the intrinsic iatrogenic risk of birth defects or perinatal complications, but also the general safety profile for the expectant mother. Indeed, specific adverse reactions (such as nausea, vomiting, constipation, and excessive weight gain) may aggravate the classic clinical findings of pregnancy, thus indirectly facilitating the occurrence of pregnancy complications and fetal and neonatal problems.
在过去的几年中，有几项研究经常得出相互矛盾的结果，调查了用于治疗妊娠期情绪障碍的精神药物的安全性。因此，有必要不断更新这些信息，以确保母婴对最安全的选择。
与帕罗西汀和氯米帕明暴露后早期宫内暴露相关的胎儿畸形风险似乎增加，而几乎所有抗抑郁药的产前暴露都与产前抗抑郁药暴露综合征的潜在发病有关。关于经典心境稳定剂，锂的致畸风险在历史上可能已经减轻，而丙戊酸是与胎儿畸形相关性最强的药物。丙戊酸通过胎盘暴露也与自闭症谱系障碍和婴儿神经发育迟缓的风险增加有关。非典型抗精神病药物没有显著的生殖安全性数据，尽管这些药物可能通过诱导妊娠期糖尿病间接增加胎儿畸形的发生率。
怀孕期间应避免使用氯米帕明、帕罗西汀、丙戊酸和非典型抗精神病药物。然而，当在怀孕期间开始或继续药物治疗时，临床医生不仅应考虑到先天畸形或围产期并发症的固有医源性风险，还应考虑到预期母亲的总体安全性概况。事实上，特定的不良反应（如恶心、呕吐、便秘和体重过度增加）可能会加重妊娠的典型临床发现，从而间接促进妊娠并发症以及胎儿和新生儿问题的发生。
