Avaliação do uso de medicamentos psicotrópicos durante a gravidez e a lactação : Overview de revisões sistemáticas

Abstract

Mental disorders have gained prominence in recent years due to these disorders, especially during late adolescence and early adulthood, which may coincide with the time of pregnancy. Therefore, 15% of pregnant women have a depressive or anxious event, which can happen concurrently, however there is often no follow-up of therapy and the relapse rate of depressive symptoms such as emotional and social behavior changes, which can often be disabling; these disorders have become a major public health problem with a large annual cost. Women are more susceptible to developing one of sadness, fatigue and loss of life expectancy tends to reappear. These symptoms can be extended to the postpartum period, presenting events such as Postpartum Depression and Baby blues, requiring adequate therapeutic intervention. Therefore, the rate of use of psychotropic medications has grown in recent years and raised a worrying warning about their passage through breast milk and possible teratogenic effects on children. Considering this scenario, the role of the pharmacist is essential in terms of monitoring pharmacotherapy, intervening if necessary and advising the mother and the family. In this context, publications are constantly published about these special groups and recently their association with psychotropic medications. This study aimed to analyze the main obstetric complications and teratogenic effects associated with the of these drugs during pregnancy and lactation. From this, a broad search for systematic reviews that portrayed the risks of these substances for the mother and baby was carried out in reliable databases, namely Medline/Pubmed and Scielo. The search strategy was previously defined following the PRISMA and Cochrane recommendations, the screening, eligibility, and data extraction steps were performed in duplicate in Excel® spreadsheets. A third reviewer was responsible for the decision in cases of disagreement. To assess the quality of systematic reviews, the AMSTAR scale was used. After the screening and eligibility process, 31 articles from systematic reviews were included for full reading. The main results analyzed were the risk of obstetric complications involving preterm birth, pre-eclampsia and eclampsia and a negative mother-child attachment; for the baby, the main findings involve low birth weight, cardiac malformations, and neural tube malformations. Regarding lactation, the main drug classes appear to be safe by not passing substance in large amounts through breast milk. Given the above, it can be concluded that psychotropic drugs can be used during pregnancy and lactation as long as the best treatment for the mother and the lowest risk for the baby is chosen.