2023年妊娠期抑郁癥的藥物治療專家共識（完整版）

2023年妊娠期抑郁癥的藥物治療專家共識(完整版)A:患者在2周內(nèi)經(jīng)歷5種或更多癥狀,表現(xiàn)出較既往有顯著的功能變化，循環(huán)發(fā)生障礙，而引起的心房和(或)動脈導(dǎo)管水平血液的右向左分流，重大畸形。Lassen等人對3186名妊娠期暴露于文拉法辛的嬰兒和107的統(tǒng)計學(xué)上的關(guān)聯(lián)[34]。最近的一項meta分析[35]和幾項隊列研究妊娠期高血壓的風(fēng)險(4.5%)與未接受治療(4.5%)相比無差別[47]。孕婦進行了調(diào)查，發(fā)現(xiàn)任何抗抑郁藥物暴露后自然流產(chǎn)的風(fēng)險都不顯著早產(chǎn)在Vlenterie等人的研究中，觀察到患有抑郁癥的女性早產(chǎn)風(fēng)險顯著增加(OR2.2,95%CI1.7-3.0)[57]。之前已發(fā)現(xiàn)使用SSRIs類藥物與早產(chǎn)風(fēng)險增加有關(guān)[23,50,58-60],而Lattimore等人的meta分析中顯示，早產(chǎn)的風(fēng)險不增加(1.85,95%CI:0.79-4.29)[61]。主要發(fā)現(xiàn)：早產(chǎn)風(fēng)險的結(jié)果相互矛盾，即使在控制(至少部分)潛在條件SSRIs類藥物可能通過抑制血小板中5-羥色胺的再攝取來干擾正常的血小露于SSRIs的嬰兒發(fā)生PPHN的絕對風(fēng)險為1%-2%[66],而一般新生兒對風(fēng)險在0.2%至0.3%之間[68-71]。但是母親抑郁、肥胖、吸煙和手術(shù)苯二氮卓類藥物(BDZs):在宮內(nèi)接觸BDZs的新生兒中，有20%至40%推薦1推薦2推薦3推薦4推薦5信息材料(如科普文章或科學(xué)論文),在知情情況下作出共同決定?？挂钟艏翱菇箲]的藥物治療，需要患者和醫(yī)療人員之間的合作，在決定是否、1.Kallén,B.Neonatecharacteristicsaft2.Kieviet,N.;Dolman,K.M.;Honig,A.TheuseofpsychotropicmediDis.Treat.2013,9,1257-1266.[Cro3.Laine,K;Heikkinen,T;Ekblad,U.;Kero,P.Effectsofeserotonergicsymptomsinnew4.Alwan,S;Reefhuis,J.;Rasmussen,S.A;Olney,R.S;Friedman,J.M.;NationalBirthDefectsPreventioserotonin-reuptakeinhibitorsinpregnancyandtheriskofbirth5.Davis,R.L;Rubanowice,D;McPhillips,H.;Raebel,M.A.;Andrade,S.E;Smith,D;Yood,M.U:;Platt,R;HMOforEducation,ResearchinTherapeutics.Risksofconantidepressantmedicationsduringpregnancy.Pharmacoepidemiol.Drug6.Malm,H;Artama,M.;Gissler,M;Ritvanen,A.SelectiveserotoninreuptakeinhibitorsandriskforGynecol.2011,118,111-120.7.Louik,C;Lin,A.E;Werler,M.M.;Hernandez-Diaz,S;Mitchell,A.A.First-trimesteruseofselectiveserotonin-reuptaketheriskofbirthdefects.N.Engl.J.Med.8.Oberlander,T.F;Warburton,W;Misri,S;Riggs,W;Aghajanian,J.;Hertzman,C.MajorcongenitalmalformationsfollowToxicol.2008,83,68-76.[Cro9.Wichman,C.L;Moore,K.M;Lang,T.R;StSauver,J.L;Heise,R.H.,Jr;Watson,W.J.Congenitalheartdiseaseassociatedwserotoninreuptakeinhibitoruseduringpregnancy.MayoClin10.Lassen,D;Ennis,Z.N.;Damkiermalformations:Asystematicreview.BasicClin.Pharmacol11.Hendson,L;Shah,V;Trkulja,S.Selectiveserotoninreuptakeinhibitorpregnancy:Infantandchildhoodoutcomes.Paediatr.Child.Healthdepressedpregnantwomen:Anupdatedanalysi13.Polen,K.N.;Rasmussen,S.A.;Riehle-Colarusso,T;ReefhuisClin.Mol.Teratol.2013,97,28-35.14.Huybrechts,K.F;Bateman,B.T;Pawar,A.;Bessette,L.G;Mogun,H.;Levin,R;Li,H.;Motsko,S;ScanUpadhyaya,H.P;etal.Maternalandfetaloutco15.Einarson,A.;Fatoye,B;Sarkar,M;Lavigne,S.V;Brochu,J;Chambers,C;Mastroiacovo,P;Addis,A;Matsui,D;Schuler,L;etPregnancyoutcomefollowinggestationalexposuretovenla158,1728-1730.[CrossRef]Int.J.Environ.Res.PublicHealth2023,20,656550of5716.Lassen,D;Ennis,Z.N.;Damkiermalformations:Asystematicreview.BasicClin.Pharmacol17.Richardson,J.L;Martin,F.;Dunstan,H.;Greenall,A.;Stephens,S;Yates,L.M.;Thomas,S.venlafaxineuse:Aprospectiveobservationalcomparativecohortstu19.Ankarfeldt,M.Z;Petersen,J;Andersen,LT;Li,H;Motsko,S.P;Fast,T;Hede,S.M;Jimenez-Solem,E.Exposuretoduloxetineduring20.Ban,L;Gibson,J.E;West,J;Fiaschi,L;Sokal,R;Smeeth,L;Doyle,P;Hubbard,R.B.;Tata,LJ.Maternaldepression,antidepressantprescriptions,andcongenitalanomalyriskinoffspring:Apopul21.Simon,G.E;Cunningham,M.L;Davis,R.L.Outcomesofprenatalantidepressantexposure.Aprenatalexposuretoantidepressants.J.Clin.PsychiatPsychol.Med.2010,40,1723-124.DeVries,C;Gadzhanova,S.;Sykes,MJ;Ward,M.;Roughead,E.congenitalheartdefectsofantidepressantclassesand25.Winterfeld,U.;Klinger,G;Panchaud,A;Stephens,S.;Arnon,J.;Malm,H.;TeWinkel,B;Clementi,M;Pistelli,A;Ma“náková,E.;et26.Einarson,A.;Bonari,L.;Voyer-Lavigne,S;Addis,A;Matsui,D;Johnson,Y;Kor29.Smit,M;Wennink,H;Heres,M;Dolman,K.M;Honig,A.Mirtazapineinpregnancyandlactation:D30.Dao,K;Shechtman,S;Diav-Citrin,O;George,N.;Richardson,J.L;Rollason,V;Pistelli,A;Eleftheriou,G;Berlin,M.;E35.Grigoriadis,S;Graves,L;Peer,M.;Mamisashvili,L;Dennis,C.L;Vigod,S.N.;Steiner,M;Brown,C;Cheung,A;Dawson,H;etal.100.Wang,LH.;Lin,H.C;Lin,C.C;Chen,pregnancy.Clin.Pharmacol.Ther.2010,88,369-374.[Cros40.Tinker,S.C;Reefhuis,J;Bitsko,R.H.;Gilboa,S.M;Mitchell,A.A;Tran,E.L;Werler,M.M.;PreventionStudy,1997-2011.BirthDe41.Ban,L;West,J;Gibson,J.E;Fiaschi,L;Sokal,R;Doyle,P;Hubbard,R;Smeeth,L;Tata,LJ.Firsttrimesterexposuretoanxiolytic43.Ornoy,A;Arnon,J;Shechtman,S.;Moerman,L;Lukashova,I.IsbenzodToxicol.1998,12,511-515.[Cro103.Noh,Y;Lee,H.;Choi,A;Kwon,J.S;Choe,S.A.;Chae,J;Kim,D.S;Shin,J.congenitalmalformation44.Noh,Y;Lee,H.;Choi,A;Kwon,J.S;Choe,S.A;Chae,J;Kim,D.S;Shin,J.Y.First-trimesterexposuretobenzcongenitalmalformation45.Toh,S;Mitchell,A.A;Louik,C;Werler,M.M;Chambers,C.D;Hernandez-Diaz,S.Selectivofgestationalhypertension.Am.J.Psychiatry2009,166,320-3246.deVera,M.A.;Bérard,A.AntidepressantuseduPharmacol.2012,74,362-369.[CrossRef].47.AmericanCollegeofObstetriciGynecol.2017,130,e168-e186.[CrossRef].48.Avalos,L.A.;Chen,H.;Li,D.K.Antidepressantmedicationuse,depression,andtheriskofpreeclampsia.CNS49.Vignato,J.A;Gumusoglu,S.B.;Davis,H.A.;Scroggins,S.M.;Hamilton,W.S;Brandt,D.S;Pierce,G.L;Knosp,B.A;Sant50.Grzeskowiak,L.E;Gi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