Safety of psychotropic medications in pregnancy: an umbrella review

IF 9.6 1区 医学 Q1 BIOCHEMISTRY & MOLECULAR BIOLOGY Molecular Psychiatry Pub Date : 2024-09-12 DOI:10.1038/s41380-024-02697-0
Nicholas Fabiano, Stanley Wong, Arnav Gupta, Jason Tran, Nishaant Bhambra, Kevin K. Min, Elena Dragioti, Corrado Barbui, Jess G. Fiedorowicz, Corentin J. Gosling, Samuele Cortese, Jasmine Gandhi, Gayatri Saraf, Risa Shorr, Simone N. Vigod, Benicio N. Frey, Richard Delorme, Marco Solmi
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Abstract

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.

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妊娠期精神药物的安全性:综述
权衡孕期使用精神药物的风险和益处仍然是全世界面临的一项挑战。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和胎儿的各种不良健康结果之间的关联强度。我们纳入了调查孕期精神药物暴露与任何不良健康后果之间关系的观察性研究的系统综述和荟萃分析。可信度分为令人信服、高度可信、可信、不可信或不重要。荟萃分析和单项研究的质量分别采用系统综述评估工具 2(AMSTAR 2)和纽卡斯尔-渥太华量表(NOS)进行评估。我们考虑了 21 项元分析,涉及 17,290,755 名参与者(AMSTAR 2 高 = 1,低 = 12 或极低 = 8)。证据表明(1) 任何精神障碍(等效几率比 1.62(95% 置信区间 1.24-2.12))或抑郁症(1.65 [1.34-2.02])的孕妇在怀孕任何三个月期间服用抗抑郁药都会导致早产;(2) 患有抑郁症的孕妇在怀孕任何三个月期间服用 SSRI(1.50[1.19-1.90]);以及(3) 在妊娠头三个月服用帕罗西汀的抑郁症或焦虑症孕妇,其婴儿会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])。其他关联的证据不足,或在统计学上并不显著。本综述没有发现令人信服或高度提示性的证据表明精神障碍孕妇使用精神药物会对健康造成不良影响。
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来源期刊
Molecular Psychiatry
Molecular Psychiatry 医学-精神病学
CiteScore
20.50
自引率
4.50%
发文量
459
审稿时长
4-8 weeks
期刊介绍: Molecular Psychiatry focuses on publishing research that aims to uncover the biological mechanisms behind psychiatric disorders and their treatment. The journal emphasizes studies that bridge pre-clinical and clinical research, covering cellular, molecular, integrative, clinical, imaging, and psychopharmacology levels.
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