van Ravesteyn Leontien M, Lambregtse-van den Berg Mijke P, Hoogendijk Witte J G, Kamperman Astrid M
Department of Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands.
PLoS One. 2017 Mar 30;12(3):e0173397. doi: 10.1371/journal.pone.0173397. eCollection 2017.
For women suffering from an antepartum mental disorder (AMD), there is lack of evidence-based treatment algorithms due to the complicated risk-benefit analysis for both mother and unborn child. We aimed to provide a comprehensive overview of pharmacological and non-pharmacological interventions to treat AMD and performed a meta-analysis of the estimated treatment effect on the psychiatric symptoms during pregnancy.
MedLine, PsycINFO and Embase databases were searched by two independent reviewers for clinical trials with a control condition on treatment of women with AMD, i.e. major depressive (MDD), anxiety, psychotic, eating, somatoform and personality disorders. We inventoried the effect of the treatment, i.e. decrease of psychiatric symptoms at the end of the treatment or postpartum. We adhered to the PRISMA-protocol.
Twenty-nine trials were found involving 2779 patients. Trials studied patients with depressive disorders (k = 28), and anxiety disorders (k = 1). No pharmacological trials were detected. A form of psychotherapy, like Cognitive Behavioural Therapy (g = -0.61; 95%CI:-0.73 to -0.49, I2 = 0%; k = 7) or Interpersonal Psychotherapy (g = -0.67; 95%CI:-1.27 to -0.07; I2 = 79%; k = 4), holds robust benefit for pregnant women with MDD. Body-oriented interventions (g = -0.43; 95%CI:-0.61 to -0.25; I2 = 17%; k = 7) and acupuncture (g = -0.43; 95%CI:-0.80 to -0.06; I2 = 0%; k = 2) showed medium sized reduction of depressive symptoms. Bright light therapy (g = -0.59; 95%CI:-1.25 to 0.06; I2 = 0%; k = 2), and food supplements (g = -0.51; 95%CI:-1.02 to 0.01; I2 = 20%; k = 3) did not show significant treatment effects. One study was found on Integrative Collaborative Care.
This meta-analysis found a robust moderate treatment effect of CBT for MDD during pregnancy, and to a lesser extent for IPT. As an alternative, positive results were found for body-oriented interventions and acupuncture. No evidence was found for bright light therapy and food supplements. Only non-pharmacological trials on women with MDD were found. Research on a wider range of AMD is needed.
对于患有产前精神障碍（AMD）的女性，由于对母亲和未出生胎儿的风险效益分析复杂，缺乏基于证据的治疗算法。我们旨在全面概述治疗AMD的药物和非药物干预措施，并对孕期精神症状的估计治疗效果进行荟萃分析。
两名独立评审员在MedLine、PsycINFO和Embase数据库中搜索针对患有AMD（即重度抑郁（MDD）、焦虑、精神病性、饮食、躯体形式和人格障碍）的女性进行治疗的对照临床试验。我们整理了治疗效果，即治疗结束时或产后精神症状的减轻情况。我们遵循PRISMA协议。
共找到29项试验，涉及2779名患者。试验研究了患有抑郁症（k = 28）和焦虑症（k = 1）的患者。未检测到药物试验。一种心理治疗形式，如认知行为疗法（g = -0.61；95%置信区间：-0.73至-0.49，I² = 0%；k = 7）或人际心理治疗（g = -0.67；95%置信区间：-1.27至-0.07；I² = 79%；k = 4），对患有MDD的孕妇具有显著益处。身体导向干预（g = -0.43；95%置信区间：-0.61至-0.25；I² = 17%；k = 7）和针灸（g = -0.43；95%置信区间：-0.80至-0.06；I² = 0%；k = 2）显示抑郁症状有中等程度的减轻。强光疗法（g = -0.59；95%置信区间：-1.25至0.06；I² = 0%；k = 2）和食物补充剂（g = -0.51；95%置信区间：-1.02至0.01；I² = 20%；k = 3）未显示出显著的治疗效果。找到一项关于综合协作护理的研究。
这项荟萃分析发现认知行为疗法对孕期MDD有显著的中度治疗效果，对人际心理治疗的效果稍弱。作为替代方案，身体导向干预和针灸取得了积极结果。未发现强光疗法和食物补充剂的证据。仅找到了针对患有MDD女性的非药物试验。需要对更广泛的AMD进行研究。
