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Fortschr Neurol Psychiatr 2012; 80(4): 227-240
DOI: 10.1055/s-0031-1299314
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© Georg Thieme Verlag KG Stuttgart · New York

Die Behandlung mit Psychopharmaka in der Schwangerschaft – Teil I: So wenig wie möglich, aber so viel wie nötig

Treatment with Psychopharmaca During Pregnancy – Part I: As Little as Possible but as Much as NecessaryA. Rohde1 , V. M. Dorsch2 , C. Schaefer3
  • 1Gynäkologische Psychosomatik, Zentrum für Geburtshilfe und Frauenheilkunde, Universitätsklinikum Bonn
  • 2Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Martin-Luther-Universität, Halle-Wittenberg
  • 3Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, BBGes/Charité – Universitätsmedizin Berlin
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Publication Date:
02 April 2012 (online)

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Lernziele

Der Text soll dem Leser einen Überblick über die aktuelle Studienlage zu Embryo- und Fetotoxizität der bei psychischen Störungen verwendeten Psychopharmaka vermitteln. Der Leser soll in der Lage sein, bei der Nutzen-Risiko-Abwägung bezüglich der Gabe eines Psychopharmakons in der Schwangerschaft die relevanten Aspekte zu berücksichtigen und neben möglichen Einflüssen auf das Kind die mütterlichen Faktoren einzubeziehen.

Literatur

  • 1 Monitor Familienleben 2010. Allensbach: Institut für Demoskopie; 2010 Im Internet http://www.ifd-allensbach.de ; Stand: 25.04.2011
    Search in Google Scholar
  • 2 Marneros A, Deister A, Rohde A. Affektive, schizoaffektive und schizophrene Psychosen. Berlin: Springer; 1991
    Search in Google Scholar
  • 3 Rohde A. Psychische Störungen und Reproduktion. In: Marneros A, Rohde A, (Hrsg) Geschlechtsspezifische Psychiatrie und Psychotherapie.. Stuttgart: Kohlhammer; 2007: 512-519
    Search in Google Scholar
  • 4 Krumm S, Kilian R, Becker T. „Ich werde sie sicherlich nicht einfach so in die Welt setzen …“. Der soziale Kontext des Kinderwunschs aus der Sicht von Frauen mit psychischen Erkrankungen.  Psychiat Prax. 2011;  38 23-30
    Search in Google Scholar
  • 5 Kendell R E, Chalmers J C, Platz C. Epidemiology of puerperal psychoses.  Br J Psychiatry. 1987;  150 662-673
    Search in Google Scholar
  • 6 Harlow B L, Vitonis A F, Sparen P et al. Incidence of hospitalization for postpartum psychotic and bipolar episodes in women with and without prior prepregnancy or prenatal psychiatric hospitalizations.  Arch Gen Psychiatry. 2007;  64 42-48
    Search in Google Scholar
  • 7 Grof P, Robbins W, Alda M et al. Protective effect of pregnancy in women with lithium-responsive bipolar disorder.  J Affect Disord. 2000;  61 31-39
    Search in Google Scholar
  • 8 Cohen L S, Altshuler L L, Harlow B L et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment.  JAMA. 2006;  295 499-507
    Search in Google Scholar
  • 9 Viguera A C, Nonacs R, Cohen L S et al. Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance.  Am J Psychiatry. 2000;  157 179-184
    Search in Google Scholar
  • 10 Viguera A C, Whitfield T, Baldessarini R J et al. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation.  Am J Psychiatry. 2007;  164 1817-1824
    Search in Google Scholar
  • 11 Milgrom J, Gemmill A W, Bilszta J L et al. Antenatal risk factors for postnatal depression: a large prospective study.  J Affect Disord. 2008;  108 147-157
    Search in Google Scholar
  • 12 Schaefer C, Spielmann H, Vetter K. et al .Arzneimittel in Schwangerschaft und Stillzeit. 8. Aufl München: Elsevier/Urban & Fischer; 2011
    Search in Google Scholar
  • 13 Lund N, Pedersen L H, Henriksen T B. Selective serotonin reuptake inhibitor exposure in utero and pregnancy outcomes.  Arch Pediatr Adolesc Med. 2009;  163 949-954
    Search in Google Scholar
  • 14 Banach R, Boskovic R, Einarson T et al. Long-term developmental outcome of children of women with epilepsy, unexposed or exposed prenatally to antiepileptic drugs: a meta-analysis of cohort studies.  Drug Saf. 2010;  33 73-79
    Search in Google Scholar
  • 15 Zeskind P S, Stephens L E. Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehavior.  Pediatrics. 2004;  113 368-375
    Search in Google Scholar
  • 16 Rice F, Harold G T, Boivin J et al. The links between prenatal stress and offspring development and psychopathology: disentangling environmental and inherited influences.  Psychol Med. 2010;  40 335-345
    Search in Google Scholar
  • 17 Lee H C, Lin H C. Maternal bipolar disorder increased low birthweight and preterm births: a nationwide population-based study.  J Affect Disord. 2010;  121 100-105
    Search in Google Scholar
  • 18 Rohde A, Schaefer C. Psychopharmakotherapie in Schwangerschaft und Stillzeit. Arzneisicherheit – Beratung – Entscheidungsfindung. 3. Aufl Stuttgart: Thieme; 2010
    Search in Google Scholar
  • 19 Davis R L, Rubanowice D, McPhillips H et al. HMO Research Network Center for Education, Research in Therapeutics. Risks of congenital malformations and perinatal events among infants exposed to antidepressant medications during pregnancy.  Pharmacoepidemiol Drug Saf. 2007;  16 1086-1094
    Search in Google Scholar
  • 20 Ellfolk M, Malm H. Risks associated with in utero and lactation exposure to selective serotonin reuptake inhibitors (SSRIs).  Reprod Toxicol. 2010;  30 249-260
    Search in Google Scholar
  • 21 Reis M, Källén B. Delivery outcome after maternal use of antidepressant drugs in pregnancy: an update using Swedish data.  Psychol Med. 2010;  40 1723-1733
    Search in Google Scholar
  • 22 Pederson L H, Henriksen T B, Vestergaar M et al. Selective serotonin reuptake inhibitors in pregnancy and congenital malformations: population based cohort study.  BMJ. 2009;  339 b3569
    Search in Google Scholar
  • 23 Colvin L, Slack-Smith L, Stanley F J et al. Dispensing patterns and pregnancy outcomes for women dispensed selective serotonin reuptake inhibitors in pregnancy.  Birth Defects Res A Clin Mol Teratol. 2011;  91 142-152
    Search in Google Scholar
  • 24 Gentile S, Galbally M. Prenatal exposure to antidepressant medications and neurodevelopmental outcomes: a systematic review.  J Affect Disord. 2011;  128 1-9
    Search in Google Scholar
  • 25 Scialli A R, Iannucci A R. Whole embryo culture and the identification of “teratogenicity”.  Reprod Toxicol. 2010;  29 247-248
    Search in Google Scholar
  • 26 Hallberg P, Sjöblom V. The use of selective serotonin reuptake inhibitors during pregnancy and breast-feeding: a review and clinical aspects.  J Clin Psychopharmacol. 2005;  25 59-73
    Search in Google Scholar
  • 27 Oberlander T F, Warburton W, Misri S et al. Major congenital malformations following prenatal exposure to serotonin reuptake inhibitors and benzodiazepines using population-based health data.  Birth Defects Res B Dev Reprod Toxicol. 2008;  83 68-76
    Search in Google Scholar
  • 28 Wichman C L, Moore K M, Lang T R et al. Congenital heart disease associated with selective serotonin reuptake inhibitor use during pregnancy.  Mayo Clin Proc. 2009;  84 23-27
    Search in Google Scholar
  • 29 Scialli A R. Paroxetine exposure during pregnancy and cardiac malformations.  Birth Defects Res A Clin Mol Teratol. 2010;  88 175-177
    Search in Google Scholar
  • 30 Rohde A, Dembinski J, Dorn C. Mirtazapine (Remergil) for treatment resistant hyperemesis gravidarum: rescue of a twin pregnancy.  Arch Gynecol Obstet. 2003;  268 (3) 219-221
    Search in Google Scholar
  • 31 Gentile S. Antipsychotic therapy during early and late pregnancy. A systematic review.  Schizophr Bull. 2010;  36 518-544
    Search in Google Scholar
  • 32 Reis M, Källén B. Maternal use of antipsychotics in early pregnancy and delivery outcome.  J Clin Psychopharmacol. 2008;  28 279-288
    Search in Google Scholar
  • 33 Yacobi S, Ornoy A. Is lithium a real teratogen? What can we conclude from the prospective versus retrospective studies? A review.  Isr J Psychiatry Relat Sci. 2008;  45 95-106
    Search in Google Scholar
  • 34 Harden C L, Meador K J, Pennell P B et al. Practice parameter update: management issues for women with epilepsy – focus on pregnancy: teratogenesis and perinatal outcomes.  Neurology. 2009;  73 133-141
    Search in Google Scholar
  • 35 Dolk H, Jentink J, Loane M et al. EUROCAT Antiepileptic Drug Working Group. Does lamotrigine use in pregnancy increase orofacial cleft risk relative to other malformations?.  Neurology. 2008;  71 714-722
    Search in Google Scholar
  • 36 Hunt S J, Craig J J, Morrow J I. Increased frequency of isolated cleft palate in infants exposed to lamotrigine during pregnancy.  Neurology. 2009;  72 1108
    Search in Google Scholar
  • 37 Holmes L B, Baldwin E J, Smith C R et al. Increased frequency of isolated cleft palate in infants exposed to lamotrigine during pregnancy.  Neurology. 2008;  70 2152-2158
    Search in Google Scholar
  • 38 Vajda F J, Graham J E, Hitchcock A A et al. Is lamotrigine a significant human teratogen? Observations from the Australian Pregnancy Register.  Seizure. 2010;  19 558-561
    Search in Google Scholar
  • 39 Williams G, King J, Cunningham M et al. Fetal valproate syndrome and autism: additional evidence of an association.  Dev Med Child Neurol. 2001;  43 202-206
    Search in Google Scholar
  • 40 Matalon S, Schechtman S, Goldzweig G et al. The teratogenic effect of carbamazepine: a meta-analysis of 1255 exposures.  Reprod Toxicol. 2002;  16 9-17
    Search in Google Scholar
  • 41 Dolovich L R, Addis A, Vaillancourt J M et al. Benzodiazepine use in pregnancy and major malformations or oral cleft: meta-analysis of cohort and case-control studies.  BMJ. 1998;  317 839-843
    Search in Google Scholar

Prof. Dr. Anke Rohde

Gynäkol. Psychosomatik, Universitätsfrauenklinik

Sigmund-Freud-Str. 25

53105 Bonn

Email: anke.rohde@ukb.uni-bonn.de