Antipsychotika in der Schwangerschaft: eine systematische Übersichtsarbeit

Antipsychotics during pregnancy: a systematic review

Zusammenfassung

Hintergrund

Nutzen und Risiken der Behandlung mit Antipsychotika während der Schwangerschaft müssen sorgfältig und individuell abgewogen werden, da Antipsychotika die Plazentaschranke durchdringen können und eine Verordnung off-label ist

Fragestellung

Bei der Behandlung von Frauen im gebärfähigen Alter stellen sich insbesondere Fragen zur Teratogenität, zum Risiko für Fehl- und Totgeburten sowie zu perinatalen Komplikationen und postnatal anhaltenden Störungen, aber auch z. B. Schwangerschaftsdiabetes?

Methode

Es wird ein systematischer Literaturüberblick gegeben, der eine Hilfe bei der Auswahl von Psychopharmaka in der Schwangerschaft bieten soll und bei der Entscheidung darüber, ob eine antipsychotische Behandlung, die bei Schwangerschaft begonnen, fortgesetzt oder umgestellt wird, Unterstützung bietet.

Ergebnisse

Große, gut angelegte und kontrollierte Studien fehlen. Ein Großteil der Studien deutet aber darauf hin, dass die Gruppe der Antipsychotika in Bezug auf Teratogenität in der Schwangerschaft zumindest in Monotherapie sicher zu sein scheint.

Schlussfolgerungen

Bei der Behandlung psychischer Erkrankungen in der Schwangerschaft bedarf es einer individuellen Nutzen-Risiko-Abwägung zwischen der Gefährdung von Mutter und Kind durch eine unbehandelte psychische Störung ohne Medikamenteneinnahme und einer angemessenen Behandlung, die den Einsatz einer Medikation einschließen und die eine potenzielle Gefährdung des Kindes bedeuten kann. Unter Beachtung einiger Regeln und bei geeigneter Auswahl des Antipsychotikums kann das Risiko für das Neugeborene wie für die Mutter in der Schwangerschaft minimiert werden. Eine Entscheidung, wie mit der Medikation fortgefahren wird, kann aus den Ergebnissen dieser Arbeit nur indirekt getroffen werden.

Abstract

Background

The benefits and risks of treatment with antipsychotics during pregnancy must be weighed up carefully and individually because antipsychotics can penetrate the placental barrier and prescription is off-label.

Objective

Evaluation of the risks and benefits of administering antipsychotics during pregnancy or for women who wish to become pregnant regarding teratogenic effects, risk of fetal death and stillbirths, perinatal complications, persisting postnatal impairments or disorders and gestational diabetes.

Methods

A systematic review of the literature is provided to aid the selection of psychotropic drugs during pregnancy and in determining whether to begin, continue or switch an antipsychotic treatment during pregnancy.

Results

Large, well-designed and controlled studies are missing; however, most studies suggest that the group of antipsychotics seem to be safe in terms of teratogenicity during pregnancy, at least in monotherapy.

Conclusion

Treating mental illnesses during pregnancy requires an individual assessment of the benefits and risks. The risk of an untreated mental illness versus the benefit of a suitable treatment with antipsychotics and the potential harm to the infant must be evaluated. If certain rules are observed and a suitable antipsychotic is selected the risk to the newborn child and/or mother during pregnancy can be minimized, however, a decision about subsequent medication can only be indirectly made from the results of this study.

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Correspondence to Prof. Dr. med. Thomas Hillemacher.

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Interessenkonflikt

T. Hillemacher, S. Simen, M.‑K. Rehme und H. Frieling geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Hillemacher, T., Simen, S., Rehme, MK. et al. Antipsychotika in der Schwangerschaft: eine systematische Übersichtsarbeit. Nervenarzt (2020). https://doi.org/10.1007/s00115-020-01006-8

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Schlüsselwörter

  • Antipsychotika
  • Schwangerschaft
  • Transplazentare Exposition
  • Anomalien
  • Fehlgeburten
  • Totgeburten
  • Schwangerschaftsdiabetes

Keywords

  • Antipsychotics
  • Pregnancy
  • Transplacental exposure
  • Anomalies
  • Fetal death
  • Stillbirths
  • Gestation diabetes