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中华妇幼临床医学杂志(电子版) ›› 2025, Vol. 21 ›› Issue (03) : 304 -312. doi: 10.3877/cma.j.issn.1673-5250.2025.03.008

所属专题： 文献；

论著

抗精神疾病药物孕期治疗对严重精神障碍孕妇妊娠结局的临床分析
程碧辉1,†(), 勾竹2, 周茜1, 杨晓敏1, 李容1   
  1. 1绵阳市第三人民医院（四川省精神卫生中心）妇产科，绵阳　621000
    2广元市第三人民医院（广元市精神卫生中心）妇产科，广元　628000
  • 收稿日期:2025-01-16 修回日期:2025-05-10 出版日期:2025-06-01
  • 通信作者: 程碧辉

Clinical analysis of antipsychotic drug treatment during pregnancy on pregnancy outcomes in women with severe mental illness

Bihui Cheng1,†(), Zhu Gou2, Xi Zhou1, Xiaomin Yang1, Rong Li1   

  1. 1Department of Obstetrics and Gynecology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang 621000, Sichuan Province, China
    2Department of Obstetrics and Gynecology, The Third People′s Hospital of Guangyuan (Guangyuan Mental Health Center), Guangyuan 628000, Sichuan Province, China
  • Received:2025-01-16 Revised:2025-05-10 Published:2025-06-01
  • Corresponding author: Bihui Cheng
  • Supported by:
    Science and Technology Plan Project of Science & Technology Department of Sichuan Province(2023YFQ005)
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引用本文：

程碧辉, 勾竹, 周茜, 杨晓敏, 李容. 抗精神疾病药物孕期治疗对严重精神障碍孕妇妊娠结局的临床分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2025, 21(03): 304-312.

Bihui Cheng, Zhu Gou, Xi Zhou, Xiaomin Yang, Rong Li. Clinical analysis of antipsychotic drug treatment during pregnancy on pregnancy outcomes in women with severe mental illness[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2025, 21(03): 304-312.

目的

探讨抗精神疾病药物(APD)孕期治疗对严重精神障碍(SMI)孕妇妊娠结局的影响。

方法

选择2021年1月至2023年12月四川省精神卫生中心与广元市精神卫生中心收治的51例SMI孕妇为研究对象。采取回顾性分析方法，按照SMI孕妇孕期治疗方案，将其分别纳入观察组1(n＝ 22，对SMI孕妇孕期持续采取APD治疗)，观察组2(n＝29，仅在SMI孕妇病情加重时采取APD治疗)。选取同期在上述2家医院进行产前检查并顺利在上述2家医院分娩的健康孕妇纳入对照组(n＝68)。采用《阳性与阴性症状量表(PANSS)》《社会功能缺陷评定量表(SDSS) 》《自杀风险评估表》和《肇事、肇祸风险评估表》评价SMI孕妇分娩后的精神疾病症状，记录其SMI加重/复发情况。观察组1、2 SMI孕妇上述评分及SMI加重/复发率比较，采用成组t检验与χ2检验。对3组孕妇孕期并发症和妊娠结局，以及分娩新生儿结局进行统计学分析。观察组1、2 SMI孕妇与对照组孕妇的年龄、受教育程度、居住地、产次等一般临床资料比较，差异均无统计学意义(P>0.05)。观察组1、2 SMI孕妇SMI病程与类型比较，差异均无统计学意义(P>0.05)。本研究遵循的程序符合四川省精神卫生中心与广元市精神卫生中心伦理委员会制定的标准，并通过四川省精神卫生中心伦理委员会批准[伦理批号：2021年审(1)号]。

结果

①3组孕妇GDM发生率总体比较，差异有统计学意义(χ2＝13.08、P＝0.003)；进一步两两比较结果显示，观察组1孕妇妊娠期糖尿病(GDM)发生率，均显著高于观察组2和对照组，并且差异均有统计学意义(χ2＝6.30、P＝0.012，χ2＝9.78、P＝0.002)。②分娩后，观察组1孕妇SMI加重/复发率、PANSS评分、SDSS评分、自杀风险评分及肇事、肇祸风险评分，均较观察组2显著降低，并且差异均有统计学意义(P<0.05)。③3组孕妇分娩新生儿转入新生儿重症监护病房(NICU)占比总体比较，差异有统计学意义(P<0.05)；进一步两两比较结果显示，观察组1孕妇分娩新生儿转入NICU占比显著高于对照组，差异均有统计学意义(P＝0.008)，其余两两比较，差异均无统计学意义(P>0.05)。观察组1、2 SMI孕妇分娩新生儿的出生体重、出生身长、出生后5 min Apgar评分及早产、先天畸形发生率等比较，差异均无统计学意义(P>0.05)。

结论

对SMI孕妇采取APD孕期治疗，可改善精神状态，降低孕期SMI加重/复发风险，并且未显著增加母儿不良妊娠结局风险。

关键词: 精神障碍，严重, 抗精神疾病药物, 妊娠结局, 糖尿病，妊娠, 重症监护病房，新生儿, 孕妇
Objective

To explore the impact of antenatal antipsychotic drug (APD) treatment on pregnancy outcomes in pregnant women with severe mental illness (SMI).

Methods

A total of 51 pregnant women with SMI admitted to Sichuan Mental Health Center and Guangyuan Mental Health Center from January 2021 to December 2023 were selected as research subjects. They were divided into observation group 1 (n=22, receiving continuous APD treatment during pregnancy) and observation group 2 (n=29, receiving APD treatment only when SMI symptoms worsened) based on clinical treatment regimens. A total of 68 healthy pregnant women who underwent prenatal examinations and delivered in the same two hospitals during the same period were included into control group. The Positive and Negative Syndrome Scale (PANSS), Social Disability Screening Schedule (SDSS), Suicide Risk Assessment Scale, and Risk Assessment Scale for Endangering Behavior were used to evaluate the disease symptoms of SMI pregnant women after delivery, and the aggravation/recurrence of SMI was recorded. The scores of disease symptoms and SMI aggravation/recurrence rates between observation group 1 and 2 were compared by independent-samples t test and chi-square test. Statistical analyses were performed on pregnancy complications, pregnancy outcomes, and neonatal outcomes, among the three groups. There were no statistically significant differences in general clinical data, such as age, educational level, residence, and parity between observation groups 1, 2 and the control group (P>0.05). Additionally, no significant differences were found in the course and type of SMI between observation group 1 and 2 (P>0.05). This study complied with the standards formulated by the Ethics Committees of Sichuan Mental Health Center and Guangyuan Mental Health Center, and was approved by the Ethics Committee of Sichuan Mental Health Center (Ethics No. 2021-1).

Results

①There was a statistically significant difference in the overall incidence of gestational diabetes mellitus (GDM) among the three groups (χ2=13.08, P=0.003). Further pairwise comparisons showed that the incidence of GDM in observation group 1 was significantly higher than that in observation group 2 (χ2=6.30, P=0.012) and the control group (χ2=9.78, P=0.002). ②After delivery, the aggravation/recurrence rate of SMI, PANSS score, SDSS score, suicide risk score, and risk score for endangering behavior in observation group 1 were significantly lower than those in observation group 2 (P<0.05). ③There was a statistically significant difference in the proportion of newborns transferred to the neonatal intensive care unit (NICU) among the three groups (P<0.05). Further pairwise comparisons revealed that the proportion in observation group 1 was significantly higher than that in the control group (P=0.008), while no significant differences were found in other pairwise comparisons (P>0.05). No significant differences were observed in neonatal outcomes, such as birth weight, birth length, 5-minute Apgar score, and incidence of preterm birth and congenital malformation between observation group 1 and 2 (P>0.05).

Conclusions

APD treatment for pregnant women with SMI can improve their mental status, reduce the risk of SMI aggravation/recurrence during pregnancy, and does not significantly increase the risk of adverse maternal and neonatal outcomes.

Key words: Mental disorders, severe, Antipsychotic drugs, Pregnancy outcome, Diabetes, gestational, Intensive care units, neonatal, Pregnant women
表1 本研究3组孕妇一般临床资料比较
组别 例数 年龄(岁，±s) 受教育程度[例数(%)] 居住地[例数(%)] 产次[次，M(Q1，Q3)]
初中及以下 高中及以上 乡镇 城市
观察组1 22 30.7±4.6 8(36.4) 14(63.6) 10(45.5) 12(54.5) 1(1，2)
观察组2 29 31.1±4.2 10(34.5) 19(65.5) 12(41.4) 17(58.6) 1(1，2)
对照组 68 31.5±4.3 25(36.8) 43(63.2) 29(42.6) 39(57.4) 2(1，2)
统计量   t＝0.25 χ2＝0.05 χ2＝0.09 χ2＝3.51
P值   0.781 0.977 0.957 0.173
表2 观察组1、2 SMI孕妇SMI病程与类型构成比比较
组别 例数 SMI病程(年，±s) SMI类型[例数(%)]
精神分裂症 双向情感障碍 其他精神障碍
观察组1 22 8.4±1.7 12(54.5) 7(31.8) 3(13.6)
观察组2 29 8.2±1.7 15(51.7) 10(34.5) 4(13.8)
统计量   t＝0.44 χ2＝0.05
P值   0.665 0.977
表3 本研究3组孕妇孕期并发症和母儿妊娠结局比较
组别 例数 分娩孕龄(周，±s) 死胎[例数(%)] 妊娠期高血压疾病[例数(%)] GDM[例数(%)] 胎膜早破[例数(%)]
观察组1 22 38.2±1.7 1(4.5) 6(27.3) 10(45.5) 5(22.7)
观察组2 29 38.3±1.8 1(3.4) 3(10.3) 4(13.8) 3(10.3)
对照组 68 38.5±1.8 0(0) 7(10.3) 8(11.8) 4(5.9)
统计量   F＝0.36 —a χ2＝4.43 χ2＝13.08 χ2＝5.20
P值   0.700 0.182 0.145 0.003 0.077
表4 观察组1、2 SMI孕妇分娩后SMI相关量化指标比较
组别 例数 PANSS评分(分，±s) SDSS评分(分，±s) 自杀风险评分(分，±s) 肇事、肇祸风险评分(分，±s) SMI加重/复发[例数(%)]
观察组1 22 8.1±1.6 1.5±0.2 3.3±0.4 0.4±0.1 5(22.7)
观察组2 29 11.4±2.1 2.0±0.3 4.9±0.7 0.7±0.1 16(55.2)
统计量   t＝5.67 t＝5.84 t＝9.60 t＝11.83 χ2＝5.44
P值   <0.001 <0.001 <0.001 <0.001 0.020
表5 本研究3组孕妇分娩新生儿结局比较
组别 例数 出生体重(kg，±s) 出生身长(cm，±s) 出生后5 min Apgar评分(分，±s) 早产[例数(%)] 转入NICU[例数(%)] 足月低出生体重儿[例数(%)] 足月巨大儿[例数(%)] 性别[例数(%)]
男 女
观察组1 22 3.3±0.5 49.1±1.8 8.6±1.5 4(18.2) 3(13.6) 4(18.2) 3(13.6) 10(45.5) 12(54.5)
观察组2 29 3.2±0.4 48.9±1.7 8.6±1.6 3(10.3) 1(3.4) 2(6.9) 1(3.4) 12(41.4) 17(58.6)
对照组 68 3.2±0.4 49.2±1.8 8.7±1.6 4(5.9) 0(0) 3(4.4) 1(1.5) 29(42.6) 39(57.4)
统计量   t＝0.64 t＝0.26 t＝0.07 —a —a —a —a χ2＝0.09
P值   0.527 0.768 0.935 0.678 0.023 0.305 0.205 0.957
表6 本研究3组孕妇分娩新生儿出生后1个月的疼痛评分、神经发育和睡眠状况比较(分，±s)
组别 例数 N-PASS评分 NBNA评分 SDSC评分
观察组1 22 2.2±0.4 38.0±2.3 61.2±7.5
观察组2 29 2.2±0.4 38.5±2.2 62.0±7.8
对照组 68 2.3±0.3 38.9±2.3 62.6±7.9
F值   0.37 1.18 0.26
P值   0.688 0.310 0.774
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