背景:关于妊娠期使用抗抑郁药和抗焦虑药的共识正在临床不确定性领域发展。尽管近年来发表了许多研究,仍然缺乏权威的循证适应症,可用于指导怀孕期间这些药物的处方,而文献数据复杂,需要专家判断才能得出明确的结论。
方法:为了阐述共识,我们参与了该部门的科学协会,即,意大利毒理学会,意大利神经精神药理学会,意大利精神病学会,意大利妇产科学会,意大利药物成瘾学会和意大利成瘾病理学学会。来自不同医学专业的跨学科专家团队(毒理学家,药理学家,精神病医生,妇科医生,新生儿学家)首先成立是为了确定共识背后的需求。团队,在其确定的结构中,包括上述科学学会的所有代表;该小组的任务是评估最认可的国际文献,并在文献系统回顾和各种讨论会议的帮助下使用“名义组技术”的方法,达成文件的起草和最终批准。
结果:确定了以下五个调查领域:(1)妊娠期焦虑和抑郁障碍管理的重要性,确定与未经治疗的孕妇抑郁症相关的风险。(2)评价妊娠期使用抗抑郁药和抗焦虑药的畸形总体风险。(3)抗抑郁药/抗焦虑药治疗的孕妇后代新生儿适应障碍的评估。(4)宫内暴露于抗抑郁/抗焦虑药物后婴儿认知发育或行为的长期结果。(5)阿片类药物滥用孕妇抑郁障碍的药物治疗评价。
结论:考虑到现有技术,因此,首先有必要根据文献中现有的数据,对需要抗抑郁药和抗焦虑药治疗的孕妇进行药理学选择。必须特别注意风险/效益比的评估,了解治疗对妊娠和胎儿结局的潜在风险方面的治疗益处,以及治疗和不治疗之间的比较风险;在选择处方中,专家需要意识到药物治疗的潜在风险以及未治疗或未治疗的疾病的同等重要风险。
The initiative of a
consensus on the topic of antidepressant and anxiolytic drug use in pregnancy is developing in an area of clinical uncertainty. Although many studies have been published in recent years, there is still a paucity of authoritative evidence-based indications useful for guiding the prescription of these drugs during pregnancy, and the data from the literature are complex and require expert judgment to draw clear conclusions.
For the elaboration of the
consensus, we have involved the scientific societies of the sector, namely, the Italian Society of Toxicology, the Italian Society of Neuropsychopharmacology, the Italian Society of Psychiatry, the Italian Society of Obstetrics and Gynecology, the Italian Society of Drug Addiction and the Italian Society of Addiction Pathology. An interdisciplinary team of experts from different medical specialties (toxicologists, pharmacologists, psychiatrists, gynecologists, neonatologists) was first established to identify the needs underlying the
consensus. The team, in its definitive structure, includes all the representatives of the aforementioned scientific societies; the task of the team was the evaluation of the most accredited international literature as well as using the methodology of the \"Nominal Group Technique\" with the help of a systematic review of the literature and with various discussion meetings, to arrive at the drafting and final approval of the document.
The following five areas of investigation were identified: (1) The importance of management of anxiety and depressive disorders in pregnancy, identifying the risks associated with untreated maternal depression in pregnancy. (2) The assessment of the overall risk of malformations with the antidepressant and anxiolytic drugs used in pregnancy. (3) The evaluation of neonatal adaptation disorders in the offspring of pregnant antidepressant/anxiolytic-treated women. (4) The long-term outcome of infants\' cognitive development or behavior after in utero exposure to antidepressant/anxiolytic medicines. (5) The evaluation of pharmacological treatment of opioid-abusing pregnant women with depressive disorders.
Considering the state of the art, it is therefore necessary in the first instance to frame the issue of pharmacological choices in pregnant women who need treatment with antidepressant and anxiolytic drugs on the basis of data currently available in the literature. Particular attention must be paid to the evaluation of the risk/benefit ratio, understood both in terms of therapeutic benefit with respect to the potential risks of the treatment on the pregnancy and on the fetal outcome, and of the comparative risk between the treatment and the absence of treatment; in the choice prescription, the specialist needs to be aware of both the potential risks of pharmacological treatment and the equally important risks of an untreated or undertreated disorder.