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精神药物在哺乳期女性中的使用

Authors
Shari I Lusskin, MD, FAPA
Shaila Misri, MD, FRCPC
Section Editors
Peter P Roy-Byrne, MD
Charles J Lockwood, MD, MHCM
Deputy Editor
David Solomon, MD
Translators
姜荣环, 主任医师

引言

所有精神药物都会被运输进入乳汁(运输的量各异)，从而传递给接受母乳喂养的婴儿。对产后哺乳期女性使用药物治疗必须权衡两方面的风险，即其对婴儿可能有害的药物效应的风险，以及不治疗母体精神疾病引起母/儿后遗症的风险。婴儿通过母乳而暴露于药物的潜在风险包括：药物毒性，以及对婴儿神经行为发育的不确定长期影响。另一个关注点是，如果母体在妊娠期间也使用了精神药物，是否会发生累积效应。理论上来说，丢弃药物浓度达到峰值时分泌的乳汁会降低婴儿的药物暴露；然而，此做法不切实际，也不太可能产生任何临床益处，因此并不推荐[1,2]。

美国儿科学会(American Academy of Pediatrics, AAP)药物委员会提供了数百种常处方的可能进入乳汁的药物及其他物质的信息。分为以下几类：

  • 细胞毒性药物
  • 有不良反应的滥用药物
  • 放射活性化合物
  • 作用不明但“可能值得注意”的药物
  • 应“谨慎”使用的药物
  • 通常“允许母乳喂养时使用”的药物

药物数据库(包括UpToDate的药物信息数据库)通常引用这些信息。然而，并无该领域的随机试验。用药期间母乳喂养相对安全性相关的推荐，多数基于病例报告和实验室研究。然而，下文列出的数据表明，大多数婴儿经母乳接触的抗抑郁药和抗精神病药物的量通常很低且无临床意义，但也有例外的情况。母乳对于正常的新生儿具有非常重要的临床意义，因此让新生儿停用母乳会使其无法获得确证的母乳喂养益处。因此，母乳喂养的益处通常超过使用精神药物的相对较小风险[3]。

然而，不应以母亲的精神健康为代价进行母乳喂养。若母亲选择进行母乳喂养，为降低复发风险，尽量减少其睡眠剥夺(例如，夜间让一名家庭成员用奶瓶给婴儿喂奶)也非常重要。

                              

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Literature review current through: 2017-07 . | This topic last updated: 2017-07-28.
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