Trifu Simona Corina, Popescu Alexandra, Marian Maria Alina
Department of Neurosciences, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Department of Psychiatry, 'Alex. Obregia̓ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania.
Exp Ther Med. 2020 Oct;20(4):3474-3482. doi: 10.3892/etm.2020.8989. Epub 2020 Jul 13.
Fetal development, especially in the first trimester, has proven to be heavily influenced by external factors, such as chemical intake of medication. Chronic psychiatric treatment might interfere with the anatomical and physiological wellbeing of the fetus, because psychotropic medication proceeds past the placenta, into the amniotic fluid, and can enter breast milk. Hence some of the medications prescribed for mood disorders should be reconsidered during pregnancy, without sub-optimally treating when it is needed. A literature review is presented which systematically collects modern data and synthesizes previous interdisciplinary research findings on the safety of psychiatric treatment for affective disorders during pregnancy (term-based) and lactation. Antidepressants and mood stabilizers, fundamental strategies in treating affective disorders, have been classified by the FDA as C respectively D drugs pertaining to their risk, with some exception. Most guidelines recommend pharmacologically treating moderate-severe depression, preferably with SSRIs. Evidence advocates that drugs should be used during pregnancy only if clearly needed and the benefit outweighs the risk to the fetus. However, guidelines the American College of Obstetricians and Gynecologists state that antidepressants are a preferred first course of treatment and does not take into account the severity of the depression. Among mood-stabilizers, lithium is considered to be the safest option for pregnant women. Anticonvulsants have a higher risk of teratogenicity compared with lithium, with lamotrigine being the safest one. All mood stabilizers should be recommended in the lowest effective doses. There is controversy regarding the safety of second-generation antipsychotics during pregnancy and further research is required. Several case reports and meta-reviews have been published in order to emphasize the safety of electroconvulsive therapy (ECT) during pregnancy, but practitioners still stigmatize this procedure. Evaluating the overall risk-benefit ratio should be assessed by the medical care provider, taking into consideration current findings.
胎儿发育，尤其是在孕早期，已被证明会受到外部因素的严重影响，比如药物的化学摄入。长期的精神科治疗可能会干扰胎儿的解剖学和生理健康，因为精神药物会穿过胎盘，进入羊水，还可能进入母乳。因此，一些用于治疗情绪障碍的药物在孕期应重新考虑，而不是在需要时进行不充分的治疗。本文进行了文献综述，系统收集了现代数据，并综合了以往关于孕期（按孕周）和哺乳期情感障碍精神科治疗安全性的跨学科研究结果。抗抑郁药和心境稳定剂是治疗情感障碍的基本策略，美国食品药品监督管理局（FDA）根据其风险将它们分别归类为C类和D类药物，但有一些例外情况。大多数指南推荐对中度至重度抑郁症进行药物治疗，最好使用选择性5-羟色胺再摄取抑制剂（SSRI）。有证据表明，只有在明确需要且对胎儿的益处大于风险时，才应在孕期使用药物。然而，美国妇产科医师学会的指南指出，抗抑郁药是首选的一线治疗方法，并未考虑抑郁症的严重程度。在心稳定剂中，锂被认为是孕妇最安全的选择。与锂相比，抗惊厥药有致畸风险更高，而拉莫三嗪是最安全的一种。所有心境稳定剂都应推荐使用最低有效剂量。关于第二代抗精神病药物在孕期的安全性存在争议，需要进一步研究。为了强调孕期电休克治疗（ECT）的安全性，已经发表了几篇病例报告和荟萃综述，但从业者仍然对这种治疗方法存在偏见。医疗服务提供者应评估总体风险效益比，同时考虑当前的研究结果。
