Costoloni Giulia, Pierantozzi Elisa, Goracci Arianna, Bolognesi Simone, Fagiolini Andrea
Psychiatr Pol. 2014 Sep-Oct;48(5):865-87. doi: 10.12740/pp/25834.
The purpose of this review is to give useful information to guide clinicians when treating pregnant women affected by bipolar disorder. This review focuses on mood stabilizers including lithium, sodium valproate, carbamazepine, oxcarbazepine, gabapentin, lamotrigine and topiramate. Data have been extracted from a MEDLINE search. Data from prospective, retrospective and case-control studies as well as systematic reviews, meta-analysis and data from Pregnancy Registry were included. Major congenital malformations as well as specific malformations were reported for each drug. Preliminary findings seem to identify lamotrigine as one ofthe safest antiepileptic drugs to be used in pregnancy. Teratogenity risk oftopiramate is still largely unknown and there are not enough studies to draw even preliminary conclusions. Preliminary studies failed to report an increased risk for major congenital malformations among gabapentin or.oxcarbazepine exposed pregnancies. Even if raising less concern when compared to valproate, carbamazepine should be avoided for its documented teratogenity risk. Valproate seems to be the worst considering major congenital malformations, specific malformations as,well as its detrimental effects on neurodevelopment. On the other hand, lithium might be considered a good option when treating pregnant women affected by bipolar disorder. Given the limited research on mood stabilizers in pregnancy, clinicians need to be very careful when treating child bearing age women. Clinicians have to balance the potential teratogenityrisk against that of untreated mental illness considering individual circumstances such as severity of illness and risk of relapse.
本综述的目的是提供有用信息，以指导临床医生治疗患有双相情感障碍的孕妇。本综述重点关注心境稳定剂，包括锂盐、丙戊酸钠、卡马西平、奥卡西平、加巴喷丁、拉莫三嗪和托吡酯。数据来自MEDLINE检索。纳入了前瞻性、回顾性和病例对照研究的数据，以及系统评价、荟萃分析和妊娠登记处的数据。报告了每种药物的主要先天性畸形以及特定畸形。初步研究结果似乎表明拉莫三嗪是孕期使用的最安全的抗癫痫药物之一。托吡酯的致畸风险在很大程度上仍然未知，而且没有足够的研究得出哪怕是初步结论。初步研究未能报告加巴喷丁或奥卡西平暴露妊娠中主要先天性畸形风险增加。尽管与丙戊酸盐相比引起的担忧较少，但鉴于已记录的致畸风险，应避免使用卡马西平。考虑到主要先天性畸形、特定畸形以及对神经发育的有害影响，丙戊酸盐似乎是最差的选择。另一方面，锂盐可能被认为是治疗患有双相情感障碍孕妇的一个好选择。鉴于孕期心境稳定剂的研究有限，临床医生在治疗育龄妇女时需要非常谨慎。临床医生必须根据个体情况，如疾病严重程度和复发风险，权衡潜在的致畸风险与未治疗精神疾病的风险。
