Quintrell Ebony, Russell Danielle J, Rahmannia Sofa, Wyrwoll Caitlin S, Larcombe Alexander, Kelty Erin
School of Population and Global Health, University of Western Australia, Nedlands, WA, 6009, Australia.
Respiratory Environmental Health, Wal-yan Respiratory Research Centre, The Kids Research Institute Australia, Nedlands, WA, Australia.
CNS Drugs. 2025 Jan;39(1):23-37. doi: 10.1007/s40263-024-01126-8. Epub 2024 Oct 10.
Alcohol pharmacotherapies pose unknown teratogenic risks in pregnancy and are therefore recommended to be avoided. This limits treatment options for pregnant individuals with alcohol use disorders (AUD). The information on the safety of these medications during pregnancy is uncertain, prompting a scoping review. The objective of this review was to investigate available information on the safety of alcohol pharmacotherapies in pregnancy.
Studies published between January 1990 and July 2023 were identified through searches in BIOSIS, Embase, PsycINFO and MEDLINE databases, using terms related to pregnancy and alcohol pharmacotherapies. The alcohol pharmacotherapies investigated were naltrexone, acamprosate, disulfiram, nalmefene, baclofen, gabapentin and topiramate. Studies were screened by two independent reviewers. Covidence software facilitated the management, screening and extraction of studies.
A total of 105 studies were included in the review (naltrexone: 21, acamprosate: 4, disulfiram: 3, baclofen: 3, nalmefene: 0, topiramate: 55, gabapentin: 32) with some studies investigating multiple medications. Studies investigating naltrexone's safety in pregnancy focussed on opioid use disorders, with limited evidence regarding its safety in the context of AUD. Despite concerns about higher rates of some pregnancy complications, studies generally indicate naltrexone as a safer option compared with opioid agonists or alcohol during pregnancy. Acamprosate was not clearly associated with adverse effects of exposure in pregnancy, with two pre-clinical studies suggesting potential neuroprotective properties. Disulfiram has a high risk of congenital anomalies when used in pregnancy, believed to be due to its mechanism of action. Prenatal topiramate has also been associated with an increased risk of congenital anomalies, particularly oral clefts. There were mixed results concerning the safety of prenatal gabapentin and little to no literature investigating the safety of baclofen or nalmefene during pregnancy.
There is insufficient research on the safety of alcohol pharmacotherapies in pregnancy. Despite this, given alcohol's teratogenic effects, naltrexone could be considered to help maintain abstinence in pregnant individuals with AUD, particularly when psychosocial treatments have failed.
酒精药物疗法在孕期存在未知的致畸风险，因此建议避免使用。这限制了患有酒精使用障碍（AUD）的孕妇的治疗选择。关于这些药物在孕期安全性的信息尚不确定，促使进行一项范围综述。本综述的目的是调查关于酒精药物疗法在孕期安全性的现有信息。
通过在BIOSIS、Embase、PsycINFO和MEDLINE数据库中检索，使用与孕期和酒精药物疗法相关的术语，识别1990年1月至2023年7月期间发表的研究。所研究的酒精药物疗法包括纳曲酮、阿坎酸、双硫仑、纳美芬、巴氯芬、加巴喷丁和托吡酯。由两名独立评审员筛选研究。Covidence软件协助研究的管理、筛选和提取。
本综述共纳入105项研究（纳曲酮：21项，阿坎酸：4项，双硫仑：3项，巴氯芬：3项，纳美芬：0项，托吡酯：55项，加巴喷丁：32项），一些研究调查了多种药物。研究纳曲酮在孕期安全性的研究主要集中在阿片类使用障碍，关于其在AUD背景下安全性的证据有限。尽管担心某些妊娠并发症的发生率较高，但研究总体表明，与孕期使用阿片类激动剂或酒精相比，纳曲酮是更安全的选择。阿坎酸与孕期暴露的不良反应无明显关联，两项临床前研究表明其具有潜在的神经保护特性。双硫仑在孕期使用时有较高的先天性异常风险，据信这与其作用机制有关。产前使用托吡酯也与先天性异常风险增加有关，尤其是口腔腭裂。关于产前使用加巴喷丁的安全性结果不一，几乎没有文献研究巴氯芬或纳美芬在孕期安全性。
关于酒精药物疗法在孕期安全性的研究不足。尽管如此，鉴于酒精的致畸作用，纳曲酮可被考虑用于帮助患有AUD的孕妇维持戒酒，尤其是在心理社会治疗失败时。
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