National Centre for Mental Health, 25 Vincent Drive, Edgbaston, Birmingham B15 2FG, United Kingdom.
Pharmacol Ther. 2012 Jul;135(1):71-7. doi: 10.1016/j.pharmthera.2012.03.008. Epub 2012 Mar 28.
Perinatal psychiatric disorders are important because of their adverse effects on pregnancy outcomes. The aim of this review is investigate psychotropic drugs in the management of antenatal psychiatric disorders with emphasis on the risk of harmful effects.
A systematic review of published electronic literature between January 2000 and August 2011 was conducted using the following keywords: pregnancy, pregnancy complications, neonatal complications, congenital anomalies, infant/child development, antidepressants, antipsychotics, and lithium. The search was conducted for each class of psychotropic agents. Further hand searches were conducted. Anticonvulsants were excluded.
Antidepressants are associated with increased risk of spontaneous abortions, stillbirths, preterm deliveries, respiratory distress, endocrine and metabolic disturbance. There is evidence of discontinuation syndrome and of increased risk of cardiac defects. Antipsychotics are associated with increased gestational weight and diabetes and with increased risk of preterm birth. The effects of antipsychotics on birth weight are inconclusive. In addition, the findings in relation to malformations are inconclusive. Lithium is associated with increased birth complications such as polyhydramnios, pre-eclampsia, respiratory distress syndrome, hypotonia, and preterm birth. Lithium has previously been associated with markedly increased risk of Ebstein's anomaly. However, recent re-evaluation of the data casts doubt on the previous estimates. There is evidence that lithium is associated with cardiac septal defects.
Psychotropic drugs remain an important treatment option during pregnancy to properly manage symptoms of psychiatric diseases. Clinicians need to remain aware of the potential risk of adverse effects associated with psychotropic drug treatment.
围产期精神障碍很重要，因为它们会对妊娠结局产生不良影响。本综述旨在探讨抗精神药物在治疗产前精神障碍方面的应用，重点是关注有害作用的风险。
通过使用以下关键词，对 2000 年 1 月至 2011 年 8 月间已发表的电子文献进行了系统性的回顾：妊娠、妊娠并发症、新生儿并发症、先天畸形、婴儿/儿童发育、抗抑郁药、抗精神病药和锂。针对每一类精神药物进行了搜索。此外，还进行了手工搜索。排除了抗惊厥药物。
抗抑郁药与自然流产、死胎、早产、呼吸窘迫、内分泌和代谢紊乱的风险增加相关。有停药综合征和心脏缺陷风险增加的证据。抗精神病药与妊娠期体重增加和糖尿病以及早产风险增加相关。抗精神病药对出生体重的影响尚无定论。此外，关于畸形的研究结果尚无定论。锂与羊水过多、子痫前期、呼吸窘迫综合征、低张力和早产等分娩并发症有关。锂以前与埃布斯坦畸形的风险显著增加有关。然而，最近对数据的重新评估对以前的估计值提出了质疑。有证据表明，锂与心脏间隔缺损有关。
精神药物仍然是治疗妊娠期间精神疾病的重要选择，可以有效控制精神疾病的症状。临床医生需要时刻意识到与精神药物治疗相关的潜在不良作用风险。
