Atypical Antipsychotic Drugs and Pregnancy Outcome A Prospective, Cohort Study
Atypical Antipsychotic Drugs and Pregnancy Outcome A Prospective, Cohort Study
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DOI：
10.1097/jcp.0b013e318295fe12
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发表时间：
2013-08-01
影响因子：
2.9
通讯作者：
Schaefer, Christof
中科院分区：
文献类型：
--
作者：
Habermann, Frank;Fritzsche, Juliane;Schaefer, Christof
育龄妇女经常受到精神障碍的影响，需要在怀孕期间使用抗精神病药物。在本研究中，我们前瞻性地随访了561名暴露于第二代抗精神病药物（SGA;研究队列）的孕妇，并将其与284名暴露于第一代抗精神病药物（FGA;比较队列I）的孕妇和1122名使用已知对胎儿无害的药物的孕妇（比较队列II）进行了比较。受试者通过研究所的咨询服务登记。SGA暴露的严重畸形发生率高于对照队列II（调整后的比值比，2.17; 95%置信区间，1.20-3.91），可能反映了心房和室间隔缺损的检测偏倚。出生前暴露于SGA（15.6%）和FGA（21.6%）的婴儿发生产后疾病的频率显著高于对照队列II的4.2%。研究队列（17%）和比较队列I（21%）中选择性终止妊娠的累积发生率显著高于比较队列II（3%），而自然流产率无差异。死产和新生儿死亡的数量在参考范围内。早产和低出生体重在暴露于FGA的婴儿中更常见。总之，我们的研究结果并没有揭示出SGAs的主要致畸风险，这使得这一组更好的研究药物在怀孕期间的治疗选择。由于在妊娠最后一周接触SGAs或FGA的新生儿患产后疾病的风险较高，因此应在设有新生儿重症监护室的诊所计划分娩。
Women of childbearing age are often affected with psychotic disorders, requiring the use of antipsychotic medication during pregnancy. In the present study, we prospectively followed the pregnancies of 561 women exposed to second-generation antipsychotic agents (SGAs; study cohort) and compared these to 284 pregnant women exposed to first-generation antipsychotic agents (FGAs; comparison cohort I) and to 1122 pregnant women using drugs known as not harmful to the unborn (comparison cohort II). Subjects were enrolled through the Institute's consultation service. Major malformation rates of SGA exposed were higher compared to comparison cohort II (adjusted odds ratio, 2.17; 95% confidence interval, 1.20-3.91), possibly reflecting a detection bias concerning atrial and ventricular septal defects. Postnatal disorders occurred significantly more often in infants prenatally exposed to SGAs (15.6%) and FGAs (21.6%) compared to 4.2% of comparison cohort II. Cumulative incidences of elective terminations of pregnancy were significantly higher in both the study cohort (17%) and comparison cohort I (21%) compared to comparison cohort II (3%), whereas the rates of spontaneous abortions did not differ. The numbers of stillbirths and neonatal deaths were within the reference range. Preterm birth and low birth weight were more common in infants exposed to FGAs. To conclude, our findings did not reveal a major teratogenic risk for SGAs, making the better studied drugs of this group a treatment option during pregnancy. Because neonates exposed to SGAs or FGAs in the last gestational week are at higher risk of postnatal disorders, delivery should be planned in clinics with neonatal intensive care units.