2023年妊娠期抑郁症的药物治疗专家共识（完整版）

2023年妊娠期抑郁症的药物治疗专家共识(完整版)A:患者在2周内经历5种或更多症状,表现出较既往有显著的功能变化，循环发生障碍，而引起的心房和(或)动脉导管水平血液的右向左分流，重大畸形。Lassen等人对3186名妊娠期暴露于文拉法辛的婴儿和107的统计学上的关联[34]。最近的一项meta分析[35]和几项队列研究妊娠期高血压的风险(4.5%)与未接受治疗(4.5%)相比无差别[47]。孕妇进行了调查，发现任何抗抑郁药物暴露后自然流产的风险都不显著早产在Vlenterie等人的研究中，观察到患有抑郁症的女性早产风险显著增加(OR2.2,95%CI1.7-3.0)[57]。之前已发现使用SSRIs类药物与早产风险增加有关[23,50,58-60],而Lattimore等人的meta分析中显示，早产的风险不增加(1.85,95%CI:0.79-4.29)[61]。主要发现：早产风险的结果相互矛盾，即使在控制(至少部分)潜在条件SSRIs类药物可能通过抑制血小板中5-羟色胺的再摄取来干扰正常的血小露于SSRIs的婴儿发生PPHN的绝对风险为1%-2%[66],而一般新生儿对风险在0.2%至0.3%之间[68-71]。但是母亲抑郁、肥胖、吸烟和手术苯二氮卓类药物(BDZs):在宫内接触BDZs的新生儿中，有20%至40%推荐1推荐2推荐3推荐4推荐5信息材料(如科普文章或科学论文),在知情情况下作出共同决定。抗抑郁及抗焦虑的药物治疗，需要患者和医疗人员之间的合作，在决定是否、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;Gilbert,A.L;Morrison,J.L.Neonataloutcomesafterinhibitors.J.Clin.Psychopharmacol.2012,32,615-621.[Cros51.Dandjinou,M.;Sheehy,O;Bérard,A.Ancase-controlstudy.BMJ2019,9,e025908.[52.Wartko,PD;Weiss,N.S;Enquobahrie,DA.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