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Yıl:2013; Cilt: 3; Sayı: 4>> Özet
Psikiyatride Güncel; 2013;3(4):323-335
Duygudurum dengeleyicileri ve antipsikotiklerin fetus üzerine etkileri
E Yazıcı, N Aydın
Kocaeli Derince Eğitim ve Araștırma Hastanesi, Kocaeli
Gebelikte kullanılan ilaçların fetüs üzerine etkileri başlıca intrauterin ölüm, teratojenite ve organ malformasyonları, büyüme-gelişme geriliği, toksik etki, yenidoğan döneminde toksisite ve çekilme belirtileri ve uzun dönemde de nöro-davranışsal sorunlar şeklinde olabilmektedir. Duygudurum dengeleyicilerden lityum, eski bilgilerin aksine, yeni verilerle daha masum bir ilaç haline gelirken; son yıllarda daha çok kullanılır hale gelen valproik asit, nöral tüp defekti nedeniyle özellikle perinatal dönemde kullanımı riskli ilaçlar arasına girmiştir. Depresif epizodlarla giden duygudurum bozukluğu olgularında lamotrijin daha düşük riskli gibi görünmektedir. Tipik antipsikotiklerin kısa ve uzun sürede fetüs üzerine etkileri ile ilgili yayın sayısı atipiklere kıyasla daha çok olup doğumsal anomali açısından genel toplumdaki risk üzerinde bir risk görünmemektedir. Yine de fetüste doğum sonrası dönemde ekstrapiramidal sistem (EPS) belirtileri oluşturma ihtimali kullanımlarını kısıtlamaktadır. Atipik antipsikotikler bu yönden daha güvenilir olmakla beraber metabolik yan etkilerin gebelik komplikasyonlarına yol açabilmesi yanı sıra uzun dönemde fetüs açısından kalp-damar sistemi hastalıklarına da yatkınlaştırıcı olabilmesi nedeniyle özenli bir hasta seçimini ve komplikasyonlar açısından dikkatli ve düzenli bir takibi gerektirmektedirler. Özellikle gebeliğin ilk üç-ayında mümkünse tek ilaç ve kullanılabilen en düşük doz kullanımı fetüsün maruziyetini azaltarak daha güvenli bir gebelik sürecini sağlayabilir. İlaçların fetus üzerindeki etkilerini ve kullanım risklerini değerlendirirken o bireye özgü hastalık seyri ve yaşam şartları gibi faktörleri de ele alarak aileyle birlikte karar vermek en uygun yaklaşım olacaktır.
Effects of mood stabilizers and antipsychotics on fetus
Fetal effects of drugs used during pregnancy can mainly occur as intrauterine death, teratogenicity and organ malformations, growth retardation, toxic effect, toxicity in the neonatal period and withdrawal symptoms, and in the long-term neurobehavioral problems. While lithium, one of the mood stabilizers, unlike the old information became a more innocent drug with recent data; valproic acid, which has been more widely used in recent years, became a risky drug especially in perinatal period because of neural tube defects. Lamotrigine seems to have lower risk in mood disorder cases with depressive episodes. References about short and long term effects of typical antipsychotics on fetus is higher than that of atypical ones, suggesting not more risk than the risk in general population in terms of congenital anomalies. Still, their extrapyramidal system (EPS) side effect potential on fetus during postpartum period, limits their usage. Although atypical antipsychotics are more reliable in this respect, they require a careful patient selection and careful and regular monitoring in terms of complications because of having metabolic side effects resulting in pregnancy complications and causes long term tendency of fetus to diseases of the cardiovascular system. Especially in the first three months of pregnancy, using single medication with lowest effective dose will decrease the fetal exposure to drug and provide a safer course of pregnancy. Having regard to the factors such as the individual course of the disease and living conditions and deciding with family will be the best approach while evaluating the effects and the risks of the drugs on fetus.

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