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 Психические расстройства и беременность

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Psychotropinka
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СообщениеТема: Психические расстройства и беременность   Сб Авг 06, 2011 2:31 pm

Effect of Maternal Mental Illness on Pregnancy Outcomes
Many pregnant women experience psychiatric disorders in their childbearing years. Emerging research shows mental illness not only affects the mother's well-being but may also have significant effects on fetal outcomes. This review details what is known about the prevalence of mental illness during pregnancy as well as how such disorders may influence pregnancy outcomes. Maternal depression during pregnancy is an independent risk factor for low fetal birthweight and premature delivery, but other illnesses, such as anxiety disorders, eating disorders and psychotic illness, may also predict adverse birth outcomes. Possible behavioral, genetic and neuroendocrine mechanisms for these relationships are presented. Principles of treatment for psychiatric disorders during pregnancy are also discussed, with an emphasis on the role of the obstetrical provider.
http://www.medscape.com/viewarticle/573947


Maternal mental disorders and pregnancy outcomes: A clinical study in a Japanese population
Abstract
Aim:  To assess the maternal and neonatal outcomes of pregnant women with mental disorders in Japan. Material and Methods:  We conducted this retrospective cohort study to examine the patients who delivered at Nagoya University Hospital (2005-2009). Thereafter, the patients without any complications other than mental disorders and with several sources of psychiatric information were included in the present series, and the maternal and neonatal outcomes between patients with or without maternal mental disorders were compared. The psychiatric outcomes and the adverse effects of psychotropic drugs were also examined. Results:  A total of 1649 women delivered during this period, and 63 of them were complicated by maternal mental disorders. After the selection of patients for comparison purposes, women with mental disorders (n = 51) had a slightly but significantly shorter gestational age (39.2 ± 0.2 vs 39.8 ± 0.1 weeks, P = 0.003) and smaller birth weight (2993.0 ± 56.7 vs 3152.4 ± 23.6 g, P = 0.010) compared with the control group (n = 278). Intervention by psychiatrists was required for only 10 patients, and no patients required termination of pregnancy due to exacerbation of mental disorders. In schizophrenia patients who were taking atypical antipsychotics and benzodiazepine, a significant increase in maternal gestational weight gain, and a significant shorter gestational age were detected, respectively, compared with patients who were not receiving any drug treatments. Conclusion:  A trend towards a lower birth weight and shorter gestational age was observed in Japanese women with well-controlled mental disorders, but the effect of well-controlled mental disorders on the perinatal outcome was minimal.
© 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.
http://www.ncbi.nlm.nih.gov/pubmed/21535304


A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction.

Abstract
CONTEXT:
Maternal depressive symptoms during pregnancy have been reported in some, but not all, studies to be associated with an increased risk of preterm birth (PTB), low birth weight (LBW), and intrauterine growth restriction (IUGR).
OBJECTIVE:
To estimate the risk of PTB, LBW, and IUGR associated with antenatal depression. Data Sources and
STUDY SELECTION:
We searched for English-language and non-English-language articles via the MEDLINE, PsycINFO, CINAHL, Social Work Abstracts, Social Services Abstracts, and Dissertation Abstracts International databases (January 1980 through December 2009). We aimed to include prospective studies reporting data on antenatal depression and at least 1 adverse birth outcome: PTB (<37 weeks' gestation), LBW (<2500 g), or IUGR (<10th percentile for gestational age). Of 862 reviewed studies, 29 US-published and non-US-published studies met the selection criteria.
DATA EXTRACTION:
Information was extracted on study characteristics, antenatal depression measurement, and other biopsychosocial risk factors and was reviewed twice to minimize error.
DATA SYNTHESIS:
Pooled relative risks (RRs) for the effect of antenatal depression on each birth outcome were calculated using random-effects methods. In studies of PTB, LBW, and IUGR that used a categorical depression measure, pooled effect sizes were significantly larger (pooled RR [95% confidence interval] = 1.39 [1.19-1.61], 1.49 [1.25-1.77], and 1.45 [1.05-2.02], respectively) compared with studies that used a continuous depression measure (1.03 [1.00-1.06], 1.04 [0.99-1.09], and 1.02 [1.00-1.04], respectively). The estimates of risk for categorically defined antenatal depression and PTB and LBW remained significant when the trim-and-fill procedure was used to correct for publication bias. The risk of LBW associated with antenatal depression was significantly larger in developing countries (RR = 2.05; 95% confidence interval, 1.43-2.93) compared with the United States (RR = 1.10; 95% confidence interval, 1.01-1.21) or European social democracies (RR = 1.16; 95% confidence interval, 0.92-1.47). Categorically defined antenatal depression tended to be associated with an increased risk of PTB among women of lower socioeconomic status in the United States.
CONCLUSIONS:
Women with depression during pregnancy are at increased risk for PTB and LBW, although the magnitude of the effect varies as a function of depression measurement, country location, and US socioeconomic status. An important implication of these findings is that antenatal depression should be identified through universal screening and treated.
http://www.ncbi.nlm.nih.gov/pubmed/20921117

Depression during pregnancy
Abstract
About 11% of pregnant women suffer from a major depression requiring treatment. If left untreated, there are specific risks such as preterm delivery or low birth weight. The initial difficulty lies in diagnosing the depression itself, since many depressive symptoms are falsely ascribed to the pregnancy. A further challenge is choosing the appropriate therapy. Treatment options are psychotherapy, antidepressants, electroconvulsive therapy (ECT), or the new option of light therapy. The choice of the most suitable treatment needs to be done together with the pregnant woman after careful clarification of the potential risks of each treatment option.
http://www.ncbi.nlm.nih.gov/pubmed/21043017


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СообщениеТема: ГТР, ПР и беременность   Сб Авг 06, 2011 2:39 pm

Medications for Panic Disorder and Generalized Anxiety Disorder During Pregnancy
Objective: Approximately 30% of women experience some type of anxiety disorder during their lifetime. In addition, some evidence exists that anxiety disorders can affect pregnancy outcomes. This article reviews the literature on the course of generalized anxiety disorder (GAD) and panic disorder during pregnancy and the postpartum period and presents guidelines for management.
Data Sources and Study Selection: An English language electronic search of relevant studies using PubMed (January 1, 1985–January 2004) was performed using the search terms anxiety and pregnancy, maternal mental illness, panic and pregnancy, psychotropic medications in pregnancy, and treatment options in pregnancy. Review articles and primary pharmacologic treatment articles were selected for discussion.
Data Extraction and Synthesis: Despite the extensive use of psychotropic drugs such as antidepressants during pregnancy, there is a scarcity of information regarding the effect of such exposure on the developing fetus. Review articles and primary pharmacologic treatment trials were analyzed and incorporated into the review based on adequate methodology, completeness of data, and information on pregnancy outcome.
Conclusion: It is important that physicians understand the course of these disorders during pregnancy and available treatments so they appropriately counsel women who are or intend to become pregnant. The goal of treatment during pregnancy and lactation is sufficient treatment for syndrome remission. To minimize the potential for neonatal withdrawal and maternal toxicity after delivery, vigilant monitoring of side effects is indicated. Also, if possible, nonpharmacologic treatment, such as cognitive-behavioral therapy, should be first-line treatment in pregnant women with GAD or panic disorder.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1163270/
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СообщениеТема: Беременность и лечение депрессии   Сб Авг 06, 2011 2:40 pm

Беременность не должна являться поводом для отказа от лечения депрессии. Нелеченая депрессия представляет гораздо более серьезную угрозу для жизни и здоровья женщины и плода, чем лечение.

На данный момент известен только один антидепрессант, у которого доказана способность повышать риск осложнений беременности - это пароксетин.

Остальные антидепрессанты такими доказательствами не располагают.
Препаратами выбора, однако, являются те препараты, которые насчитывают наибольшее количество наблюдений у беременных женщин с положительным результатом и поэтому могут считаться безопасными.
Это амитриптилин, из группы СИОЗС сертралин, циталопрам, эсциталопрам и флуоксетин (при планировании грудного вскармливания предпочтителен сертралин), а из группы ингибиторов обратного захвата серотонина и норадреналина - венлафаксин.

Дулоксетин (Симбалта) обладает меньшим количеством наблюдений и поэтому не являются препаратом выбора.
Однако применение его возможно в ситуации, когда их применение обеспечит какое-либо значимое преимущество по сравнению с препаратами выбора. Применение Иксела (милнаципрана) при беременности дожно быть исключено, это даже не препарат второй линии - опыт применения препарата у беременных отсутствует, а в опытах на животных были признаки тератогенности.


Вышеперечисленные антидепрессанты выбора при беременности не повышают риск осложнений и нарушений развития плода. Однако при лечении антидепрессантами беременных рекомендуется в конце третьего триместра снизить дозу или приостановить лечение, для профилактики нервозности новорожденного и нарушенной адаптации в раннем постнатальном периоде. Но данные явления не представляют серьезной опасности для ребенка, и при необходимости лечение может не меняться. Следует лишь известить акушеров и неонатологов о лечении.

Противоэпилептические средства при беременности могут повышать риск осложнений в разной степени, однако ламотриджин, судя по имеющимся данным, наиболее безопасен из хорошо изученных препаратов и является антиэпилептиком выбора при беременности.

(с) http://forums.rusmedserv.com/showpost.php?p=1110813&postcount=3

http://www.jptcp.com/jptcp10-067_363...ll-pdf-r170033

http://www.cjcp.ca/jptcp10067_e331-e335_ddavis-r169824
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