Arch Genl Psychiat：孕妇服用抗精神病药或增糖尿病风险

最新一期的美国《普通精神病学文献》（Archives of General Psychiatry）杂志刊登了瑞典的一项研究发现，孕妇服用抗精神病药会增加患妊娠期糖尿病的风险。

领导研究的瑞典乌普萨拉大学的罗伯特·博登解释说，如果妇女患有精神分裂症或躁郁症，即使在妊娠期间也需要服用抗精神病药。本次研究就是想了解孕妇服用抗精神病药是否会有副作用。

研究人员在4年时间里调查了36万余名孕妇。其中169人在服用第二代抗精神病药奥氮平或氯氮平或2种药物一起服用，338人在服用其他类型的抗精神病药，其余的人则没有服用过任何抗精神病药。

研究发现，孕妇服用抗精神病药并患上妊娠糖尿病的风险是没有服药的孕妇的2.4倍。

doi:10.1001/archgenpsychiatry.2011.1870
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Antipsychotics During Pregnancy: Relation to Fetal and Maternal Metabolic Effects

Robert Bodén, MD, PhD; Maria Lundgren, MD, PhD; Lena Brandt, BSc; Johan Reutfors, MD, PhD; Helle Kieler, MD, PhD

Context Knowledge about the effects of exposure to the newer antipsychotics during pregnancy is limited. Objective To investigate the effects of maternal use of antipsychotics during pregnancy on gestational diabetes and fetal growth. Design Population-based cohort study comparing women exposed and not exposed to antipsychotics during pregnancy. Exposure was defined as prescriptions filled. Setting Swedish national health registers. Participants All women giving birth in Sweden from July 1, 2005, through December 31, 2009, grouped by filled prescriptions for (1) olanzapine and/or clozapine, the most obesogenic and diabetogenic antipsychotics (n = 169), (2) other antipsychotics (n = 338), or (3) no antipsychotics (n = 357 696). Main Outcome Measures Odds ratios (ORs) with 95% CIs for gestational diabetes and being small for gestational age (SGA) and large for gestational age for birth weight, birth length, and head circumference. Results Exposure to other antipsychotics was associated with an increased risk of gestational diabetes (adjusted OR, 1.77 [95% CI, 1.04-3.03]). The risk increase with olanzapine and/or clozapine was of similar magnitude but not statistical significance (adjusted OR, 1.94 [95% CI, 0.97-3.91]). Infants exposed to either group of antipsychotics had increased risks of being SGA on birth weight, whereas only exposure to other antipsychotics yielded increased risks of being SGA for birth length and head circumference. None of the risks for SGA measurements remained significant after adjusting for maternal factors. There were no increased risks of being large for gestational age for birth weight or birth length after exposure to olanzapine and/or clozapine, but the risk increased for head circumference (OR, 3.02 [95% CI, 1.60-5.71]). Conclusions Women who used antipsychotics during pregnancy had increased risks of gestational diabetes. The increased risks of giving birth to an SGA infant seemed to be an effect of confounders, such as smoking. Except for macrocephaly, olanzapine and/or clozapine exposure was not associated with anabolic fetal growth.