Risk of recurrence of mood disorders during pregnancy and the impact of medication: A systematic review.

Autor: Stevens AWMM; Dimence Mental Health, Center for Bipolar Disorders, Deventer, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands. Electronic address: a.stevens@dimence.nl., Goossens PJJ; Dimence Mental Health, Center for Bipolar Disorders, Deventer, the Netherlands; University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium., Knoppert-van der Klein EAM; GGZ Rivierduinen Alphen a/d Rijn, the Netherlands., Draisma S; Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health research Institute, GGZ inGeest Specialized Mental Health Care, Research and Innovation Amsterdam, the Netherlands., Honig A; Department of Psychiatry OLVG/msterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands., Kupka RW; Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
Jazyk: angličtina
Zdroj: Journal of affective disorders [J Affect Disord] 2019 Apr 15; Vol. 249, pp. 96-103. Date of Electronic Publication: 2019 Feb 07.
DOI: 10.1016/j.jad.2019.02.018
Abstrakt: Background: Mood disorders can be difficult to treat during pregnancy. There is still lack of evidence whether pregnancy influences their natural course and whether continuation of pharmacotherapy, despite potential risks for the unborn child, is beneficial in preventing recurrence of mood episodes during pregnancy.
Methods: Systematic review conducted according to the PRISMA guidelines, searching Pubmed, PsycINFO, Embase and Cochrane databases up till January 9th, 2018. Recurrence rates and various measures of risk were calculated.
Results: Out of 1387 articles from an initial search 22 studies met the inclusion criteria. Included studies reported a wide variation in the recurrence rate of bipolar disorder and major depressive disorder during pregnancy (BD: mean = 19%, range = 4%-73%; MDD: mean = 8%, range = 1%-75%). Observational data showed a relative risk reduction of maintenance therapy during pregnancy of 66% in women with BD and 54% for women with MDD, a significant difference (95% CI 9.4-14.6; p < 0.001).
Limitations: heterogeneous samples, study designs, and reported outcomes in included studies.
Conclusions: Despite the importance of the topic there is a paucity of evidence on recurrence rates of mood episodes during pregnancy among women with MDD or BD. Unlike the impact of the postpartum period, it is still uncertain whether the course of mood disorders is influenced by pregnancy. Non-randomized studies show that maintenance pharmacotherapy during pregnancy in women with mood disorders significantly (p < 0.01) reduces the risk of recurrence.
(Copyright © 2019. Published by Elsevier B.V.)
Databáze: MEDLINE
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