Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands.
Department of Psychiatry, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
BMC Med. 2018 Nov 15;16(1):208. doi: 10.1186/s12916-018-1192-6.
It is presumed that pharmacological and non-pharmacological treatment of prenatal common mental disorders can mitigate associated adverse effects in offspring, yet strong evidence for the prophylactic benefits of treatment is lacking. We therefore examined the effect of prenatal treatments for common mental disorders on offspring outcomes.
For this meta-analysis, articles published up to August 31, 2017, were obtained from PubMed, PsycInfo, Embase, and Cochrane databases. Included studies needed to be randomized controlled trials (RCTs) on the effect of treatment of prenatal common mental disorders comparing an intervention to a control condition, including offspring outcome(s). Random effects models were used to calculate Hedges' g in the program Comprehensive Meta-Analysis (version 3.0).
Sixteen randomized controlled trials among 2778 pregnant women compared offspring outcomes between prenatal interventions and control groups. There were zero pharmacological, 13 psychological, and three other interventions (homeopathy, relaxation interventions, and short psycho-education). Birth weight (mean difference 42.88 g, g = 0.08, 95% CI -0.06 to 0.22, p = 0.27, n = 11), Apgar scores (g = 0.13, 95% CI -0.28 to 0.54, p = 0.53, n = 4), and gestational age (g = 0.03, 95% CI -0.06 to 0.54, p = 0.49, n = 10) were not significantly affected. Other offspring outcomes could not be meta-analyzed due to the inconsistent reporting of offspring outcomes and an insufficient number of studies.
Non-pharmacological interventions had no significant effect on birth outcomes, although this outcome should be considered with caution due to the risk of biases. No randomized controlled trial examined the effects of prenatal pharmacological treatments as compared to treatment as usual for common mental disorders on offspring outcomes. Present clinical guidelines may require more research evidence on offspring outcomes, including child development, in order to warrant the current recommendation to routinely screen and subsequently treat prenatal common mental disorders.
PROSPERO CRD42016047190.
人们推测，对产前常见精神障碍进行药理学和非药理学治疗可以减轻其对后代的不良影响，但缺乏治疗具有预防作用的确凿证据。因此，我们研究了产前治疗常见精神障碍对后代结局的影响。
在这项荟萃分析中，检索了截至 2017 年 8 月 31 日在 PubMed、PsycInfo、Embase 和 Cochrane 数据库发表的文章。纳入的研究需要是比较产前常见精神障碍治疗的干预措施与对照条件对后代结局影响的随机对照试验（RCT），包括（一个或多个）后代结局。采用 Comprehensive Meta-Analysis（版本 3.0）程序计算 Hedges'g 的随机效应模型。
在 2778 名孕妇中，有 16 项 RCT 比较了产前干预与对照组的后代结局。有 0 项药理学干预、13 项心理学干预和 3 项其他干预（顺势疗法、放松干预和短期心理教育）。出生体重（均值差 42.88g，g=0.08，95%CI -0.06 至 0.22，p=0.27，n=11）、阿普加评分（g=0.13，95%CI -0.28 至 0.54，p=0.53，n=4）和胎龄（g=0.03，95%CI -0.06 至 0.54，p=0.49，n=10）均无显著影响。由于后代结局报告不一致和研究数量不足，其他后代结局无法进行荟萃分析。
非药理学干预对出生结局没有显著影响，但由于存在偏倚风险，这一结果应谨慎考虑。没有随机对照试验研究过产前药理学治疗与常见精神障碍的常规治疗相比对后代结局的影响。目前的临床指南可能需要更多关于后代结局（包括儿童发育）的研究证据，以便为目前筛查和随后治疗产前常见精神障碍的建议提供依据。
PROSPERO CRD42016047190。
