孕期选择性5-羟色胺再摄取抑制剂暴露安全性的研究进展

Research progress on the safety of exposure to selective serotonin reuptake inhibitors during pregnancy

选择性5-羟色胺再摄取抑制剂(SSRI)是治疗孕期抑郁症的常用药物,目前没有一种SSRI被明确推荐用于孕期抑郁症的治疗。妊娠期使用SSRI可能存在流产及死产的风险,但可能存在其他混杂因素的影响;相较于其他SSRI,帕罗西汀及氟西汀致畸的风险较大,舍曲林和西酞普兰安全性较高;孕晚期使用SSRI,新生儿可能出现停药症状以及新生儿持续性肺动脉高压(PPHN),其中舍曲林引起PPHN的风险较低;SSRI对婴幼儿的远期影响目前还存在争议。孕期抑郁症用药方案的制定需要权衡利弊,不应因药物风险而停用,相较于继续用药,停药带来的风险可能更大。

Selective serotonin reuptake inhibitors(SSRIs)are commonly used in treatment for patients with depression during pregnancy.However,none of the SSRIs is recommended for the treatment of depression during pregnancy.Using SSRIs during pregnancy may attribute to the risk of miscarriage and stillbirth,but there may be other confounding factors.Compared with other SSRIs,paroxetine and fluoxetine have higher risk of teratogenicity,and sertraline and citalopram have higher safety.In the third trimester of pregnancy,SSRIs may cause withdrawal symptoms in neonates and persistent pulmonary hypertension of the newborn(PPHN),of which sertraline has a lower risk of PPHN.The long-term effects of SSRIs on infants are still controversial.The formulation of medications for depression during pregnancy needs to weigh the pros and cons and the drugs should not be discontinued due to the potential risks.The risk of drug withdrawal may be higher than that of continuing to use the drug.