Fabiano Nicholas, Wong Stanley, Gupta Arnav, Tran Jason, Bhambra Nishaant, Min Kevin K, Dragioti Elena, Barbui Corrado, Fiedorowicz Jess G, Gosling Corentin J, Cortese Samuele, Gandhi Jasmine, Saraf Gayatri, Shorr Risa, Vigod Simone N, Frey Benicio N, Delorme Richard, Solmi Marco
SCIENCES Lab, Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Mol Psychiatry. 2025 Jan;30(1):327-335. doi: 10.1038/s41380-024-02697-0. Epub 2024 Sep 12.
Weighing risks and benefits of the use of psychotropic medications during pregnancy remains a challenge worldwide. We systematically assessed the strength of associations between psychotropic medication use in pregnant people with mental disorders and various adverse health outcomes in both pregnant people and foetuses. Systematic reviews with meta-analyses of observational studies investigating the association between exposure to psychotropic medication in pregnancy and any adverse health outcomes were included. Credibility was graded into convincing, highly suggestive, suggestive, weak or not significant. Quality of the meta-analyses and of individual studies were assessed with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) the Newcastle-Ottawa Scale (NOS), respectively. We considered 21 meta-analyses encompassing 17,290,755 participants (AMSTAR 2 high = 1, low = 12, or critically low = 8). Evidence was suggestive for: (1) preterm birth in pregnant people with either any mental disorder (equivalent odds ratio 1.62 (95% confidence interval 1.24-2.12) or depression (1.65 [1.34-2.02]) receiving antidepressants during any trimester of pregnancy; (2) small for gestational age for pregnant people with depression receiving a SSRI during any trimester of pregnancy (1.50 [1.19-1.90]); and (3) major congenital malformation (1.24 [1.09-1.40]) or cardiac malformations (1.28 [1.11-1.47]) in babies for pregnant people with depression or anxiety receiving paroxetine during first trimester of pregnancy. Additional associations were supported by weak evidence, or were not statistically significant. This umbrella review found no convincing or highly suggestive level of evidence of adverse health outcomes associated with psychotropic medication use in pregnant people with mental disorders.
权衡孕期使用精神药物的风险和益处仍是全球面临的一项挑战。我们系统地评估了患有精神障碍的孕妇使用精神药物与孕妇及胎儿各种不良健康结局之间关联的强度。纳入了对观察性研究进行荟萃分析的系统评价，这些研究调查了孕期接触精神药物与任何不良健康结局之间的关联。可信度分为令人信服、高度提示、提示、微弱或不显著。分别使用《评估系统评价的测量工具2》（AMSTAR 2）和纽卡斯尔-渥太华量表（NOS）评估荟萃分析和个体研究的质量。我们纳入了21项荟萃分析，涉及17290755名参与者（AMSTAR 2高 = 1，低 = 12，或极低 = 8）。有证据提示：（1）患有任何精神障碍（等效优势比1.62 [95%置信区间1.24 - 2.12]）或抑郁症（1.65 [1.34 - 2.02]）的孕妇在孕期任何阶段服用抗抑郁药会导致早产；（2）患有抑郁症的孕妇在孕期任何阶段服用选择性5-羟色胺再摄取抑制剂（SSRI）会导致胎儿小于胎龄（1.50 [1.19 - 1.90]）；（3）患有抑郁症或焦虑症的孕妇在孕早期服用帕罗西汀会导致婴儿出现重大先天性畸形（1.24 [1.09 - 1.40]）或心脏畸形（1.28 [1.11 - 1.47]）。其他关联得到的证据较弱，或无统计学意义。这项综合性综述未发现患有精神障碍的孕妇使用精神药物与不良健康结局之间存在令人信服或高度提示水平的证据。
