Sorbonne Université, Université de Paris, France.
Adult Psychiatry Department CHU Grenoble Alpes, Grenoble Institut Neurosciences, Université Grenoble Alpes, Inserm, U1216, Grenoble, France.
Expert Opin Pharmacother. 2022 Aug;23(11):1337-1350. doi: 10.1080/14656566.2022.2102421. Epub 2022 Jul 19.
The perinatal period in schizophrenia is associated with high risk of psychotic relapse and pregnancy/child outcomes. The extent to which antipsychotics may potentially affect the fetus or the child development is unclear and debated. Even though guidelines have been developed, there is a lack of consensual recommendations regarding the optimal strategy to manage schizophrenia during the perinatal period.
This systematic review describes the current state of evidence with respect to the impact of recommended interventions for schizophrenia during the perinatal period, including childbearing age, pregnancy, and post-partum. It compares recent international treatment guidelines for this specific group of women. Last, this review presents a set of major points to be discussed with patients and relatives for shared-decision making and a summary of key recommendations from the international guidelines.
Although treatment guidelines may be of significant help, discrepancies exist across them regarding the management of antipsychotics for schizophrenia women during the perinatal period. Shared decision-making and advance directives represent useful patient-centered approaches during this specific period. Further cohort-based evidence is needed to better identify maternal and fetal risks associated to antipsychotic treatment exposure.
精神分裂症的围产期与精神病复发和妊娠/儿童结局的高风险相关。抗精神病药物是否可能对胎儿或儿童发育产生潜在影响尚不清楚，这仍存在争议。尽管已经制定了指南，但对于围产期管理精神分裂症的最佳策略，仍缺乏共识建议。
本系统评价描述了目前有关围产期（包括生育年龄、妊娠和产后）推荐干预措施对精神分裂症影响的证据现状。它比较了最近针对这一特定女性群体的国际治疗指南。最后，本文提出了一系列要点，以便与患者及其亲属进行讨论，以进行共同决策，并总结国际指南的关键建议。
虽然治疗指南可能有很大帮助，但它们在围产期管理精神分裂症女性的抗精神病药物方面存在差异。共同决策和预先指示是这一特定时期以患者为中心的有用方法。需要进一步的基于队列的证据来更好地识别与抗精神病药物治疗暴露相关的母婴风险。
