MGH Institute of Health Professions, School of Nursing, 36 1st Ave, Boston, MA, 02129, USA.
Arch Womens Ment Health. 2018 Oct;21(5):505-516. doi: 10.1007/s00737-018-0844-z. Epub 2018 Apr 11.
Psychopharmacological treatment of pregnant women is an area of continued controversy; extensive observational research on the use of antidepressant medications in pregnancy has found these medications to be associated with increased risk of spontaneous abortion, preterm delivery, and low birth weight. However, depression itself has also been associated with increased risk of those same outcomes, and only recently have researchers begun trying to compare treated with untreated depression. The purpose of this study was to conduct a systematic review of the literature to integrate those comparative studies and compare risks and benefits. PubMed, PsycInfo, and CINAHL searches; study selection; and data extraction were carried out using PRISMA guidelines. Eleven prospective observational and case-control studies were selected for final inclusion. Risk of low birth weight and related outcomes do not differ between antidepressant-treated pregnant women and untreated depressed women. Average gestational lengths tend to be slightly shorter with antidepressant use but it is unclear whether these differences are clinically meaningful or extend to preterm delivery. Very limited research on spontaneous abortion did not allow conclusions to be drawn regarding that outcome. The low number of studies meeting criteria highlights the need for further research to aid in risk-benefit analysis for women considering antidepressant use in pregnancy. While further research is necessary, discontinuing antidepressant treatment of major depression in pregnancy due to concerns about length of gestation, birth weight, or spontaneous abortion is not supported by the evidence available at this time.
精神药理学治疗孕妇是一个持续存在争议的领域；对怀孕期间使用抗抑郁药物的广泛观察性研究发现，这些药物与自然流产、早产和低出生体重的风险增加有关。然而，抑郁症本身也与这些相同结局的风险增加有关，而且研究人员最近才开始尝试比较治疗和未治疗的抑郁症。本研究的目的是对文献进行系统综述，以整合这些对照研究并比较风险和益处。使用 PRISMA 指南进行了 PubMed、PsycInfo 和 CINAHL 搜索、研究选择和数据提取。最终纳入了 11 项前瞻性观察性和病例对照研究。抗抑郁药治疗的孕妇与未经治疗的抑郁孕妇的低出生体重和相关结局的风险没有差异。使用抗抑郁药的平均妊娠期往往略短，但尚不清楚这些差异是否具有临床意义或是否延伸至早产。关于自然流产的非常有限的研究使得无法就该结局得出结论。符合标准的研究数量较少突出表明需要进一步研究，以帮助对考虑在怀孕期间使用抗抑郁药的女性进行风险效益分析。虽然需要进一步研究，但鉴于目前的证据，不支持因担心妊娠期、出生体重或自然流产而中断孕妇重度抑郁症的抗抑郁治疗。
