임신 중 정신약물 사용이 조산 및 신생아 발달에 미치는 영향에 대한 연구

Study of Adverse Effect to Preterm Labor and Fetus Development after Prenatal Psychotropic Exposure

임신 도중 정신약물 사용에 대해서 산모 및 태아에게 미치는 부작용과 정신 증상 악화 및 재발이라는 문제 사이에서 약물 사용 여부가 항상 논란이 되어 왔다. 본 연구에서는 후향적 문헌검토를 통해 단일 기관에서 18년간 주요정신질환을 진단 받은 산모에서 약물 사용 여부에 따른 재태주수와 신생아 출생력의 차이를 t-test를 통해 비교하였고, 정신약물 복용이 조산에 미치는 위험성을 다른 조산의 고위험성 원인인 고연령 산모, 임신성 고혈압, 임신성 당뇨와 비교하기 위해 로지스틱 회귀분석을 실시하였다. 그 결과 임신 도중 정신약물 사용 여부에 따라 재태 기간, 출생 체중, 아두대횡경, 1분 아프가 점수, 5분 아프가 점수의 유의미한 차이는 없었고, 조산에 미치는 위험요소로서 임신성 고혈압만이 조산의 위험성이 높아지는 것으로 확인되었다. 이로써 임신시 약물 사용에 따른 조산의 발생이나 신생아 출생력에 유의미한 문제를 야기시키지 않았음을 확인하였고 향후 임신 중인 정신질환 환자 치료시 약물치료를 포함한 다양한 치료적 대안을 고려할 필요가 있겠다.

Objective Psychotropic drugs use in pregnant mothers with psychiatric disorders raises issues of safety not only with the mothers but also with fetal development and the postpartum prognosis of the neonate. Several studies have reported on the harmful effects of antenatal exposure to psychotropic drugs. However, debatable disregard of the psychiatric disorder itself and issues of necessary and useful pharmacotherapy clouds the results. Hence, the purpose of this study was to retrospectively examine the association between prenatal psychotropic exposure and clinically evident fetal adverse effects. Methods From January 1994 to December 2011, a retrospective chart review of patients diagnosed with a major psychiatric disorder from the department of psychiatry and who also had a history of giving birth at the department of obstetrics and gynecology at Ajou University Hospital was conducted. Participants were divided into two groups: those taking psychotropic drugs during pregnancy were designated to the case group and the control group consisted of those not on psychotropics during pregnancy. Psychotropics included antidepressants, antipsychotics and benzodiazepines used in clinical dosages. Then the two groups were compared on factors such as gestational age, the offspring’s birth weight, bitemporal diameter, and Apgar scores. After then, we analyzed relatively risk potential to the preterm labor in such variables (old age pregnancy, gestational diabetes, gestational hypertension and exposure psychotropics in pregnancy). T-test and logistic regression analysis of the data was performed. Results Demographic and clinical characteristics did not differ significantly between the groups. Also, there was no significant difference in gestational age, birth weight, bitemporal diameter and Apgar scores between the exposure and non-exposure groups. There was no significant relationship between psychotropic exposure during pregnancy, old age pregnancy, gestational diabetes and preterm labor. However, the relationship between gestational hypertension and preterm labor was significant. Conclusion Psychotropic drugs are considered as significant clinical treatment options to control symptoms of psychiatric disorders during pregnancy. In the clinical setting there was no statistically significant relationship between psychotropic exposure and gestational age on fetal development. However the retrospective nature of the study limits the interpretation of the data and constant close monitoring of pregnant patients in the clinical setting is advised.