产后第一个月内，母亲抑郁、血清素再摄取抑制剂治疗以及同时使用苯二氮卓类药物对婴儿神经行为功能的影响。
The Roles of Maternal Depression, Serotonin Reuptake Inhibitor Treatment, and Concomitant Benzodiazepine Use on Infant Neurobehavioral Functioning Over the First Postnatal Month.
作者信息
Salisbury Amy L, O'Grady Kevin E, Battle Cynthia L, Wisner Katherine L, Anderson George M, Stroud Laura R, Miller-Loncar Cynthia L, Young Marion E, Lester Barry M
机构信息
From the Brown Center for the Study of Children at Risk, Women and Infants' Hospital, Providence, R.I.; the Department of Pediatrics and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I.; the Department of Psychology, University of Maryland, College Park, College Park, Md.; the Center for Women's Behavioral Health, Women and Infants' Hospital, Providence, R.I.; the Psychosocial Research Program, Butler Hospital, Providence, R.I.; the Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago; the Child Study Center, Yale University School of Medicine, New Haven, Conn.; the Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, R.I.; and the Department of Psychology, St. Joseph's College of Maine, Standish, Maine.
出版信息
Am J Psychiatry. 2016 Feb 1;173(2):147-57. doi: 10.1176/appi.ajp.2015.14080989. Epub 2015 Oct 30.
OBJECTIVE
The purpose of this article was to systematically compare the developmental trajectory of neurobehavior over the first postnatal month for infants with prenatal exposure to pharmacologically untreated maternal depression, selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors (collectively: SSRIs), SSRIs with concomitant benzodiazepines (SSRI plus benzodiazepine), and no maternal depression or drug treatment (no exposure).
METHOD
Women (N=184) were assessed at two prenatal time points to determine psychiatric diagnoses, symptom severity, and prenatal medication usage. Infants were examined with a structured neurobehavioral assessment (Neonatal Intensive Care Unit Network Neurobehavioral Scale) at multiple time points across the first postnatal month. SSRI exposure was confirmed in a subset of participants with plasma SSRI levels. General linear-mixed models were used to examine group differences in neurobehavioral scores over time with adjustment for demographic variables and depression severity.
RESULTS
Infants in the SSRI and SSRI plus benzodiazepine groups had lower motor scores and more CNS stress signs across the first postnatal month, as well as lower self-regulation and higher arousal at day 14. Infants in the depression group had low arousal throughout the newborn period. Infants in all three clinical groups had a widening gap in scores from the no-exposure group at day 30 in their response to visual and auditory stimuli while asleep and awake. Infants in the SSRI plus benzodiazepine group had the least favorable scores on the Neonatal Intensive Care Unit Network Neurobehavioral Scale.
CONCLUSIONS
Neonatal adaptation syndrome was not limited to the first 2 weeks postbirth. The profile of neurobehavioral development was different for SSRI exposure than depression alone. Concomitant benzodiazepine use may exacerbate adverse behavioral effects.
目的
本文旨在系统比较产前暴露于未经药物治疗的母亲抑郁症、选择性5-羟色胺再摄取抑制剂或5-羟色胺和去甲肾上腺素再摄取抑制剂（统称：SSRI）、联用苯二氮䓬类药物的SSRI（SSRI加苯二氮䓬类药物）以及未患母亲抑郁症或未接受药物治疗（无暴露）的婴儿在出生后第一个月的神经行为发育轨迹。
方法
在两个产前时间点对184名女性进行评估，以确定其精神疾病诊断、症状严重程度和产前用药情况。在出生后第一个月的多个时间点，用结构化神经行为评估（新生儿重症监护病房网络神经行为量表）对婴儿进行检查。在一部分参与者中通过血浆SSRI水平确认了SSRI暴露情况。使用一般线性混合模型来检验神经行为评分随时间的组间差异，并对人口统计学变量和抑郁症严重程度进行调整。
结果
在出生后的第一个月，SSRI组和联用苯二氮䓬类药物的SSRI组的婴儿运动评分较低，中枢神经系统应激体征较多，在第14天时自我调节能力较低且觉醒程度较高。抑郁症组的婴儿在整个新生儿期觉醒程度较低。在第30天，所有三个临床组的婴儿在睡眠和清醒时对视觉和听觉刺激的反应得分与无暴露组的差距都在扩大。联用苯二氮䓬类药物的SSRI组的婴儿在新生儿重症监护病房网络神经行为量表上的得分最不理想。
结论
新生儿适应综合征并不局限于出生后的前2周。SSRI暴露的神经行为发育情况与单纯抑郁症不同。联用苯二氮䓬类药物可能会加剧不良行为影响。
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