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Associationen mellan exponering av selektiva serotonin återupptagshämmare under graviditeten och ökad risk för prematur födelse och låg neonatal födelsevikt
Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
2016 (Swedish)Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
Abstract [sv]

Maternal depression drabbar mellan 5-10 % av alla gravida kvinnor. Det är vanligare än man tror att drabbas av depression under graviditeten och sjukdomen kan vara farlig för både mamman och fostret. Ungefär 2 av 3 kvinnor som tidigare har varit deprimerade har en ökad risk att drabbas av depression under graviditeten. En obehandlad långvarig depression kan vara skadlig för barnets kognitiva utveckling och ökar risken för att barn ska födas prematur eller födas med låg födelsevikt. Den bakomliggande orsaken till maternal depression är en långvarig exponering av stresshormoner som leder till att neurotransmittorer minskar. Fler möjliga orsaker är miljöfaktorer, bakomliggande sjukdomar, samt hormonförändringar. Behandlingen av maternal depression är inriktad mot samtalsterapi (KBT), kognitiv psykoterapi och farmakologisk behandling där ett noggrant övervägande av risk och nytta måste göras. Syftet med litteraturstudien var att undersöka om exponering av SSRI preparat (selektiva återupptags hämmare) under graviditeten ökar risken för prematur födelse och risk för låg neonatal födelsevikt. Sex studier granskades och hämtades från PubMed och One Search. Samtliga studier är prospektiva eller retrospektiva observationsstudier. Fem av studierna visade att det fanns en ökad risk för prematur födsel när kvinnor som behandlats med SSRI preparat under graviditeten jämfördes med kvinnor som varken var deprimerade eller behandlats med något SSRI preparat. I en studie påvisades ingen ökad risk för prematur födelse hos kvinnor med depression som avslutat SSRI behandlingen före den andra trimestern och kvinnor som behandlats med SSRI under hela graviditeten med kvinnor som inte behandlats med någon form av antidepressiva läkemedel minst 2 månader före befruktning. Två studier visade ingen ökad risk för minskad födelsevikt hos barnet, medan tre studier visade en ökad risk för lägre födelsevikt hos barnet. Den ena studien utförds även en subanalys som inte påvisade ökad risk för lägre födelsevikt hos barn som exponerats av selektiva serotonin återupptagshämmare jämfört med de barn som inte exponerats. Sammanfattningsvis ska ett noggrant övervägande mellan nytta och risk beaktas innan man ger SSRI till gravida kvinnor. Det vore intressant att se i framtida forskning större studier med specifika doser och specifika SSRI preparat för att klargöra associationen mellan exponering av selektiva serotonin återupptags hämmare under graviditeten med ökad risk för prematur födsel och låg födelsevikt hos spädbarnet.

Abstract [en]

Maternal depression is common for newly delivered mothers. In addition, about 1/5 of all pregnant women suffer from depression and about 2 out of 3 women who become depressed during pregnancy have been depressed before. The disease can be dangerous for both mother and infant. The mother may risk getting deeper depression which can lead to self-harm and suicide. The child's cognitive ability and language development may be impaired due to the central nervous system is constantly evolving during pregnancy. When the fetus is exposed to the mother's high stress levels in the body, the neonatal development may be affected and the gestational age and birth weight may be lower. It is therefore very important that women are recognized and get the right treatment in time. Many factors can cause depression, including external stresses, hormonal changes, which include elevated levels of stress hormones, and low levels of neurotransmitters.

Treatment options for depression is focused on cognitive behavioral therapy (CBT), cognitive psychomotor therapy, light therapy and pharmacologic treatment.

The purpose of this study was to study the effects of exposure to antidepressants, serotonin reuptake inhibitors (SSRIs) during pregnancy and the risks of premature birth and low birth weight at the time of delivery. The studies which are reviewed in this literature study were taken from PubMed. Six studies were selected and all studies are observation studies.

Five studies showed an increased risk of premature birth in women who used SSRIs during pregnancy compared to women who did not use SSRIs during pregnancy or had been depressed. Compared to women who had not been medicated with SSRIs during pregnancy but were depressed also showed an increased risk of giving birth preterm. In study 1 and 3 there was an increase of 50% to preterm birth and study 4 showed 20 % increased risk in women treated with SSRIs during pregnancy. In study 2, there was no association between SSRI use during pregnancy and preterm birth. In study 2 and 3, there was an increased risk of giving birth to children with lower birth weight of those women who had been medicated with SSRIs throughout pregnancy compared to women who did not use SSRIs during pregnancy and had not been depressed. Study 6 showed an increased risk of low birth weight in the population analysis, but after having compiled a family-analysis longer seen no increased risk. Study 5 examined the risk of SGA (small for gestational age < 2500 grams) instead of the birth weight, and it showed no increased risk of SGA. In summary, it is difficult to prove whether there is any association between SSRI treatment during pregnancy and increased risk of lower birth weight and increased risk of premature birth. Because studies show different associations and do not support each other, it is therefore difficult to draw concrete conclusions. For that reason it would be interesting to see more research in this area to clarify if there is any association between SSRI use during pregnancy and increased risk of preterm birth and lower birth weight.

Place, publisher, year, edition, pages
2016. , 44 p.
National Category
Pharmaceutical Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-55704OAI: oai:DiVA.org:lnu-55704DiVA: diva2:954454
Subject / course
Pharmacy
Educational program
Bachelor of Science Programme in Pharmacy, 180 credits
Supervisors
Examiners
Available from: 2016-08-25 Created: 2016-08-22 Last updated: 2016-08-25Bibliographically approved

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Kallander Lundström, Evelina
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