Safety of psychotropic medications in pregnancy: an umbrella review.

Autor: Fabiano N; SCIENCES Lab, Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada., Wong S; SCIENCES Lab, Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.; Department of Psychiatry, University of Toronto, Toronto, ON, Canada., Gupta A; Department of Medicine, University of Calgary, Calgary, AB, Canada.; College of Public Health, Kent State University, Kent, OH, US., Tran J; Department of Psychiatry, University of Toronto, Toronto, ON, Canada., Bhambra N; Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada., Min KK; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada., Dragioti E; Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece., Barbui C; WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy., Fiedorowicz JG; Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.; Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada.; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada., Gosling CJ; DysCo Laboratory, Université Paris Nanterre, F9200, Nanterre, France.; Laboratory of Psychopathology and Health Process, Université Paris Cité, F92000, Paris, France.; Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK., Cortese S; Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK.; Solent NHS Trust, Southampton, UK.; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA.; DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari 'Aldo Moro', Bari, Italy., Gandhi J; Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.; Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada., Saraf G; Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada.; The Royal's Institute of Mental Health Research, Ottawa, ON, Canada., Shorr R; Library Services, The Ottawa Hospital, Ottawa, ON, Canada., Vigod SN; Department of Psychiatry, Women's, College Hospital and University of Toronto, Toronto, ON, Canada., Frey BN; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada., Delorme R; Child and Adolescent Psychiatry Department, Robert Debré Hospital, APHP, University of Paris Cité, Paris, France., Solmi M; SCIENCES Lab, Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada. msolmi@toh.ca.; Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada. msolmi@toh.ca.; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada. msolmi@toh.ca.; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. msolmi@toh.ca.; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany. msolmi@toh.ca.
Jazyk: angličtina
Zdroj: Molecular psychiatry [Mol Psychiatry] 2024 Sep 12. Date of Electronic Publication: 2024 Sep 12.
DOI: 10.1038/s41380-024-02697-0
Abstrakt: Weighing risks and benefits of the use of psychotropic medications during pregnancy remains a challenge worldwide. We systematically assessed the strength of associations between psychotropic medication use in pregnant people with mental disorders and various adverse health outcomes in both pregnant people and foetuses. Systematic reviews with meta-analyses of observational studies investigating the association between exposure to psychotropic medication in pregnancy and any adverse health outcomes were included. Credibility was graded into convincing, highly suggestive, suggestive, weak or not significant. Quality of the meta-analyses and of individual studies were assessed with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) the Newcastle-Ottawa Scale (NOS), respectively. We considered 21 meta-analyses encompassing 17,290,755 participants (AMSTAR 2 high = 1, low = 12, or critically low = 8). Evidence was suggestive for: (1) preterm birth in pregnant people with either any mental disorder (equivalent odds ratio 1.62 (95% confidence interval 1.24-2.12) or depression (1.65 [1.34-2.02]) receiving antidepressants during any trimester of pregnancy; (2) small for gestational age for pregnant people with depression receiving a SSRI during any trimester of pregnancy (1.50 [1.19-1.90]); and (3) major congenital malformation (1.24 [1.09-1.40]) or cardiac malformations (1.28 [1.11-1.47]) in babies for pregnant people with depression or anxiety receiving paroxetine during first trimester of pregnancy. Additional associations were supported by weak evidence, or were not statistically significant. This umbrella review found no convincing or highly suggestive level of evidence of adverse health outcomes associated with psychotropic medication use in pregnant people with mental disorders.
(© 2024. The Author(s).)
Databáze: MEDLINE
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