切换至 "中华医学电子期刊资源库"
高级检索
中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2022, Vol. 18 ›› Issue (06) : 739 -744. doi: 10.3877/cma.j.issn.1673-5250.2022.06.016

论著

妊娠合并严重精神障碍精神疾病孕妇妊娠结局的临床分析
鲍引娣1, 范翠芳1, 张珺1, 孙艳梅1, 杨菁2,†()   
  1. 1武汉大学人民医院妇产科，武汉　430060
    2武汉大学人民医院生殖医学中心/湖北省辅助生殖与胚胎发育医学临床研究中心，武汉　430060
  • 收稿日期:2022-05-04 修回日期:2022-10-19 出版日期:2022-12-01
  • 通信作者: 杨菁

Clinical analysis of pregnancy outcomes of psychotic pregnant women with severe mental disorders

Yindi Bao1, Cuifang Fan1, Jun Zhang1, Yanmei Sun1, Jing Yang2,†()   

  1. 1Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
    2Reproductive Medicine Center, Renmin Hospital, Wuhan University / Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan 430060, Hubei Province, China
  • Received:2022-05-04 Revised:2022-10-19 Published:2022-12-01
  • Corresponding author: Jing Yang
  • Supported by:
    National Natural Science Foundation of China(81971356)
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

鲍引娣, 范翠芳, 张珺, 孙艳梅, 杨菁. 妊娠合并严重精神障碍精神疾病孕妇妊娠结局的临床分析[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(06): 739-744.

Yindi Bao, Cuifang Fan, Jun Zhang, Yanmei Sun, Jing Yang. Clinical analysis of pregnancy outcomes of psychotic pregnant women with severe mental disorders[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2022, 18(06): 739-744.

目的

探讨对合并严重精神障碍(SMI)孕妇采取抗精神疾病药物(APD)治疗对妊娠结局、孕期SMI变化及围生儿结局的影响。

方法

选择2017年1月至2021年12月在武汉大学人民医院住院分娩的154例SMI孕妇为研究对象。采取回顾性分析方法，将154例SMI孕妇分为研究组(n＝70，孕期使用APD治疗)和对照组(n＝84，孕期未采取APD治疗)。对2组孕妇一般临床资料、妊娠结局和并发症发生率，以及2组围生儿结局进行统计学分析。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

结果

①2组孕妇文化水平、SMI病程、孕期病情加重/APD治疗达到稳定状态后再次复发率和孕前采取APD治疗率比较，差异均有统计学意义(P<0.05)。②研究组孕妇妊娠期糖尿病(GDM)发病率为28.6%(20/70)，显著高于对照组的6.0%(5/84)，并且差异有统计学意义(χ2＝14.36，P<0.001)。③研究组孕妇分娩的生儿出生体重及身长分别为(3 247.1±497.5) g、(49.3±1.6) cm，均显著高于对照组的(2 991.9±456.9) g、(48.7±1.8) cm，并且差异均有统计学意义(t＝3.22、2.04，P＝0.002、0.043)。

结论

对合并SMI孕妇采取APD治疗，可降低已经达到病情稳定SMI孕妇的SMI复发率，有利于维持SMI孕妇的病情稳定，且对SMI孕妇及其围生儿均无明显影响。产科医师应重视对SMI孕妇合并GDM的早期筛查和管理，并对其制定个体化管理方案。

关键词: 严重精神障碍, 抗精神病药, 妊娠期糖尿病, 妊娠结局, 新生儿结局, 孕妇
Objective

To investigate the effects of antipsychotic medication during pregnancy in pregnant women complicated with severe mental illness (SMI) on maternal outcomes, pregnancy condition changes, and perinatal outcomes.

Methods

The clinical data of 154 pregnant women combined with SMI who delivered in the Renmin Hospital of Wuhan University from January 2017 to December 2021 were selected as research subjects. They were divided into experimental group (n=70, regular antipsychotics during pregnancy) and control group (n=84, without psychotropic medication) according to whether they used antipsychotics during pregnancy. The general clinical data, pregnancy outcomes, complications and perinatal outcomes of the two groups were retrospectively analyzed. The study was conducted in accordance with World Medical Association Declaration of Helsinki revised in 2013. All subjects informed consent and signed the informed consent forms for the clinical study.

Results

① There were statistically significant differences between two groups in the terms of educational level, the course of SMI, the percentage of exacerbation/relapse during pregnancy and the percentage of pre-pregnancy psychotropic medication (P<0.05). ② The prevalence of gestational diabetes mellitus (GDM) in pregnant women of experimental group was 28.6% (20/70), which was significantly higher than that in control group (6.0%, 5/84), and the difference was statistically significant (χ2=14.36, P<0.001). ③The birth weight and body length of newborns of experimental group were (3 247.1± 497.5) g and (49.3±1.6)cm, respectively, which were significantly higher or longer than those in control group (2 991.9±456.9) g and (48.7±1.8)cm, and both the differences were statistically significant (t=3.22, 2.04; P=0.002、0.043).

Conclusions

Regular antipsychotics medication in pregnancy complicated with SMI can reduce the incidence of aggravation or recurrence during pregnancy and is beneficial to maintain the stability of the condition. It has no obvious effects on maternal and perinatal outcomes, but the incidence of gestational diabetes increased, we should pay more attention to early screening of GDM and develop individualized management for the population.

Key words: Serious Mental illness, Antipsychotic agents, Gestational diabetes mellitus, Pregnancy outcome, Maternal outcomes, Pregnant women
表1 2组SMI孕妇一般临床资料比较
组别 例数 年龄(岁，±s) 文化水平[例数(%)] 居住地[例数(%)] 孕次[次，M(Q1，Q3)] 产次(次，±s)
初中及以下 高中及以上 乡镇 城市
研究组 70 30.9±3.9 23(32.9) 47(67.1) 31(44.3) 39(55.7) 1(1，2) 1.2±0.4
对照组 84 29.9±4.4 42(50.0) 42(50.0) 39(46.4) 45(53.6) 1(1，2) 1.3±0.5
统计量 t＝1.37 χ2＝4.60 χ2＝0.07 Z＝－0.05 t＝－1.96
P值 0.172 0.032 0.791 0.959 0.052
组别 例数 流产次数[次，M(Q1，Q3)] 剖宫产术分娩史[例数(%)] SMI病程[年，M(Q1，Q3)] SMI类型[例数(%)] SMI加重/复发[例数(%)] 孕前采取APD治疗[例数(%)]
精神分裂症 双相情感障碍 其他精神障碍
研究组 70 0(0，1) 5(7.1) 8.5(4.0，10.0) 47(67.1) 4(5.7) 19(27.1) 13(18.6) 65(92.9)
对照组 84 0(0，1) 15(17.9) 5.0(2.0，10.0) 49(58.3) 7(8.3) 28(33.3) 54(64.3) 36(42.9)
统计量 Z＝－1.22 χ2＝4.96 Z＝－3.00 χ2＝1.32 χ2＝32.95 χ2＝42.29
P值 0.220 0.084 0.003 0.516 <0.001 <0.001
表2 2组SMI孕妇妊娠结局及孕期并发症发生率比较
组别 例数 分娩孕龄(周，±s) 分娩方式[例数(%)] 死胎[例数(%)] 妊娠期高血压疾病[例数(%)] GDM[例数(%)] 胎膜早破[例数(%)]
阴道分娩 剖宫产术分娩
研究组 70 38.3±1.7 16(22.9) 54(77.1) 2(2.9) 11(15.7) 20(28.6) 9(12.9)
对照组 84 38.2±1.8 29(34.5) 55(65.5) 7(8.3) 7(8.3) 5(6.0) 15(17.9)
统计量 t＝0.45 χ2＝2.51 χ2＝1.20a χ2＝2.02 χ2＝14.36 χ2＝0.73
P值 0.654 0.113 0.272 0.156 <0.001 0.394
表3 2组SMI孕妇所分娩新生儿结局比较
组别 例数 出生体重(g，±s) 出生身长(cm，±s) 生后1 min Apgar评分[例数(%)] 生后5 min Apgar评分[例数(%)] 早产[例数(%)]
研究组 68 3 247.1±497.5 49.3±1.6 0(0) 0(0) 9(13.2)
对照组 77 2 991.9±456.9 48.7±1.8 3(3.9) 1(1.3) 11(14.3)
统计量 t＝3.22 t＝2.04 χ2＝3.85 χ2＝2.70 χ2＝0.03
P值 0.002 0.043 0.248 0.259 0.855
组别 例数 新生儿畸形[例数(%)] 转入NICU[例数(%)] 足月低出生体重儿[%(n/n′)]a 足月巨大儿[%(n/n′)]b 性别[例数(%)]
男 女
研究组 68 1(1.5) 4(5.9) 3.4(2/59) 10.2(6/59) 34(50.0) 34(50.0)
对照组 77 0(0) 9(11.7) 6.1(4/66) 3.0(2/66) 41(53.2) 36(46.8)
统计量 χ2＝1.52 χ2＝1.49 χ2＝0.49 χ2＝2.65 χ2＝0.15
P值 0.217 0.222 0.486 0.104 0.696
[1]
国家卫生健康委. 卫生健康委关于印发严重精神障碍管理治疗工作规范(2018年版)的通知[EB/OL]. (2018-05-28)[2022-01-09].

URL    
[2]
Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2019, 394(10204): 1145-1158. DOI: 10.1016/S0140-6736(19)30427-1.
[3]
张五芳，马宁，王勋，等. 2020年全国严重精神障碍患者管理治疗现状分析[J]. 中华精神科杂志，2022, 55(2): 122-128.
[4]
Raimondi A, Sheiner E. Pregnant women with schizophrenia are at higher risk of pre-eclampsia, venous thromboembolism and adverse neonatal outcomes[J]. Evid Based Nurs, 2015, 18(2): 39-40. DOI: 10.1136/eb-2014-101902.
[5]
Mota NP, Chartier M, Ekuma O, et al. Mental disorders and suicide attempts in the pregnancy and postpartum periods compared with non-pregnancy: a population-based study[J]. Can J Psychiatry, 2019, 64(7): 482-491. DOI: 10.1177/0706743719838784.
[6]
Raffi ER, Nonacs R, Cohen LS. Safety of psychotropic medications during pregnancy[J]. Clin Perinatol, 2019, 46(2): 215-234. DOI: 10.1016/j.clp.2019.02.004.
[7]
Alexander GC, Gallagher SA, Mascola A, et al. Increasing off-label use of antipsychotic medications in the United States, 1995-2008[J]. Pharmacoepidemiol Drug Saf, 2011, 20(2): 177-184. DOI: 10.1002/pds.2082.
[8]
王瀚，苏允爱，李继涛，等. 孕期使用抗精神病药对子代神经发育影响的研究进展[J]. 中华精神科杂志，2020, 53(4): 347-350. DOI：10.3760/cma.j.cn113661-20190726-00247.
[9]
卢逃涛. 非典型抗精神病药在孕期的用药安全性[D]. 重庆：重庆医科大学，2016.
[10]
廖雪梅，苏允爱，司天梅. 孕期服用抗精神病药安全性的临床研究[J]. 中华精神科杂志，2013，46(2): 122-124. DOI: 10.3760/cma.j.issn.1006-7884.2013.02.019.
[11]
Edvardsson K, Hughes E, Copnell B, et al. Severe mental illness and pregnancy outcomes in Australia. A population-based study of 595 792 singleton births 2009-2016[J]. PLoS One, 2022, 17(2): e264512. DOI: 10.1371/journal.pone.0264512.
[12]
Damkier P, Videbech P. The safety of second-generation antipsychotics during pregnancy: a clinically focused review[J]. CNS Drugs, 2018, 32(4): 351-366. DOI: 10.1007/s40263-018-0517-5.
[13]
Gilbert PL, Harris MJ, McAdams LA, et al. Neuroleptic withdrawal in schizophrenic patients. A review of the literature[J]. Arch Gen Psychiatry, 1995, 52(3): 173-188. DOI: 10.1001/archpsyc.1995.03950150005001.
[14]
Viguera AC, Whitfield T, Baldessarini RJ, et al. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation[J]. Am J Psychiatry, 2007, 164(12): 1817-1824, 1923. DOI: 10.1176/appi.ajp.2007.06101639.
[15]
Wakil L, Perea E, Penaskovic K, et al. Exacerbation of psychotic disorder during pregnancy in the context of medication discontinuation[J]. Psychosomatics, 2013, 54(3): 290-293.DOI: 10.1016/j.psym.2012.07.003.
[16]
Petersen I, McCrea RL, Osborn DJ, et al. Discontinuation of antipsychotic medication in pregnancy: a cohort study[J]. Schizophr Res, 2014, 159(1): 218-225. DOI: 10.1016/j.schres.2014.07.034.
[17]
Larsen ER, Saric K. Pregnancy and bipolar disorder: the risk of recurrence when discontinuing treatment with mood stabilisers: a systematic review[J]. Acta Neuropsychiatr, 2017, 29(5): 259-266. DOI: 10.1017/neu.2016.60.
[18]
Jenkins JA, Kontos N. The maudsley prescribing guidelines in psychiatry, 12th edition[J]. J Clin Psychiatry, 2016, 77(4): e469.
[19]
Ellfolk M, Leinonen MK, Gissler M, et al. Second-generation antipsychotics and pregnancy complications[J]. Eur J Clin Pharmacol, 2020, 76(1): 107-115. DOI: 10.1007/s00228-019-02769-z.
[20]
Bellet F, Beyens MN, Bernard N, et al. Exposure to aripiprazole during embryogenesis: a prospective multicenter cohort study[J]. Pharmacoepidemiol Drug Saf, 2015, 24(4): 368-380. DOI: 10.1002/pds.3749.
[21]
Sutter-Dallay AL, Bales M, Pambrun E, et al. Impact of prenatal exposure to psychotropic drugs on neonatal outcome in infants of mothers with serious psychiatric illnesses[J]. J Clin Psychiatry, 2015, 76(7): 967-973. DOI: 10.4088/JCP.14m09070.
[22]
Sadowski A, Todorow M, Yazdani BP, et al. Pregnancy outcomes following maternal exposure to second-generation antipsychotics given with other psychotropic drugs: a cohort study[J]. BMJ Open, 2013, 3(7)．DOI: 10.1136/bmjopen-2013-003062.
[23]
Reutfors J, Cesta CE, Cohen JM, et al. Antipsychotic drug use in pregnancy: a multinational study from ten countries[J]. Schizophr Res, 2020, 220: 106-115. DOI: 10.1016/j.schres.2020.03.048.
[24]
Petersen I, Sammon CJ, McCrea RL, et al. Risks associated with antipsychotic treatment in pregnancy: comparative cohort studies based on electronic health records[J]. Schizophr Res, 2016, 176(2-3): 349-356. DOI: 10.1016/j.schres.2016.07.023.
[25]
Vigod SN, Gomes T, Wilton AS, et al. Antipsychotic drug use in pregnancy: high dimensional, propensity matched, population based cohort study[J]. BMJ, 2015, 350: h2298. DOI: 10.1136/bmj.h2298.
[26]
Bodén R, Lundgren M, Brandt L, et al. Antipsychotics during pregnancy: relation to fetal and maternal metabolic effects[J]. Arch Gen Psychiatry, 2012, 69(7): 715-721. DOI: 10.1001/archgenpsychiatry.2011.1870.
[27]
Vigod SN, Kurdyak PA, Dennis CL, et al. Maternal and newborn outcomes among women with schizophrenia: a retrospective population-based cohort study[J]. BJOG, 2014, 121(5): 566-574. DOI: 10.1111/1471-0528.12567.
[28]
Park Y, Huybrechts KF, Cohen JM, et al. Antipsychotic medication use among publicly insured pregnant women in the United States[J]. Psychiatr Serv, 2017, 68(11): 1112-1119. DOI: 10.1176/appi.ps.201600408.
[29]
Park Y, Hernandez-Diaz S, Bateman BT, et al. Continuation of atypical antipsychotic medication during early pregnancy and the risk of gestational diabetes[J]. Am J Psychiatry, 2018, 175(6): 564-574. DOI: 10.1176/appi.ajp.2018.17040393.
[30]
Chen J, Huang XF, X Shao R, et al. Molecular mechanisms of antipsychotic drug-induced diabetes[J]. Front Neurosci, 2017, 11: 643. DOI: 10.3389/fnins.2017.00643.
[1] 杨皓媛, 龚杰, 邹青伟, 阮航. 哮喘孕妇的母婴不良妊娠结局研究现状[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 522-529.
[2] 陈甜甜, 王晓东, 余海燕. 双胎妊娠合并Gitelman综合征孕妇的妊娠结局及文献复习[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 559-568.
[3] 居晓庆, 金蕴洁, 王晓燕. 剖宫产术后瘢痕子宫患者再次妊娠阴道分娩发生子宫破裂的影响因素分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 575-581.
[4] 顾娟, 孙擎擎, 胡方方, 曹义娟, 祁玉娟. 子宫内膜容受性检测改善胚胎反复种植失败患者妊娠结局的临床应用[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 582-587.
[5] 王蓓蓓, 董启秀, 郗红燕, 于庆云, 张丽君, 式光. 早孕期孕妇药物流产失败的影响因素分析与构建相关预测模型及其对药物流产成功的预测价值[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 588-594.
[6] 陈絮, 詹玉茹, 王纯华. 孕妇ABO血型联合甲状腺功能检测对预测妊娠期糖尿病的临床价值[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 604-610.
[7] 周梦玲, 薛志伟, 周淑. 妊娠合并子宫肌瘤的孕期变化及其与不良妊娠结局的关系[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 611-615.
[8] 冉晨曦, 沈如飞, 廖明钰, 廖倩, 周玲, 张玉玲, 隆敏. 垂体瘤孕妇的诊治与围分娩期管理[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(04): 487-491.
[9] 陈莉, 雷雪芹, 段炼, 曾悦, 何国琳. 影响2次剖宫产术后阴道试产产妇试产成功因素及妊娠结局分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(03): 287-294.
[10] 陈樱, 陈艳莉. 高龄孕妇心率变异性原因及围产结局分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(03): 295-301.
[11] 冯丹艳, 曹晓辉, 史玉霞. 血清脂联素与胎盘亮氨酸氨肽酶对妊娠期糖尿病患者妊娠结局的影响[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(03): 302-308.
[12] 任国华, 杜晓晓, 洪善玲, 邵帅. 妊娠期高血压并发急性肾损伤患者血清白细胞介素-22、硫化氢及护骨素水平的变化与意义[J]. 中华肾病研究电子杂志, 2023, 12(03): 150-155.
[13] 张郁妍, 胡滨, 张伟红, 徐楣, 朱慧, 羊馨玥, 刘海玲. 妊娠中期心血管超声参数与肝功能的相关性及对不良妊娠结局的预测价值[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 499-504.
[14] 王欣, 刘琳, 闻哲嘉, 刘春玲, 张弘, 吕芳. 妊娠前应激暴露对小鼠后续妊娠的影响[J]. 中华临床医师杂志(电子版), 2023, 17(04): 431-437.
[15] 刘雪云, 范颖, 姚爱军, 张胜苗, 吕亚妮, 张冰清, 张晓宇, 刘恒. 基于微信小程序的个体化、全程护理干预对孕妇孕期体重及分娩结局的影响[J]. 中华临床医师杂志(电子版), 2023, 17(04): 455-460.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号