Сравнительный анализ применения селективных ингибиторов обратного захвата серотонина во время беременности и в послеродовом периоде. Безопасность сертралина

Депрессивные и тревожные расстройства являются наиболее распространенными в перинатальном периоде психическими заболеваниями, они встречаются у 14–23% женщин. Антидепрессанты из группы селективных ингибиторов обратного захвата серотонина (СИОЗС) рассматриваются как препараты выбора для лечения этих расстройств. Несмотря на то что СИОЗС являются наиболее изученными антидепрессантами, применяемыми у беременных, до сих пор существуют противоречивые мнения об их влиянии на течение и исходы гестации. При этом риски, связанные с их применением у беременных, зачастую преувеличены, а риски нелеченых психических расстройств, наоборот, недооценены. Применение СИОЗС во время беременности ассоциировалось снебольшим повышением риска неблагоприятных исходов, включая послеродовые кровотечения, выкидыши, преждевременные роды, кесарево сечение, малый для гестационного возраста размер плода и низкую массу тела при рождении, низкую оценку по шкале Апгар, а также повышение частоты госпитализации новорожденных в отделения интенсивной терапии. Однако, поскольку сами депрессивные и тревожные расстройства у матери также способствуют аналогичным исходам, дифференцировать вклад препарата и заболевания не всегда представляется возможным Сравнительные данные о влиянии разных препаратов СИОЗС на исходы беременности для матери и ребенка ограниченны, однако, по имеющимся данным, наиболее высокая опасность для плода/новорожденного связана с применением пароксетина и флуоксетина. Сведения о безопасности циталопрама и эсциталопрама в период беременности и лактации ограниченны. Для циталопрама характерны самые высокие среди всех СИОЗС концентрации в амниотической жидкости. Согласно современным данным, наиболее благоприятным профилем безопасности во время беременности и лактации обладает сертралин, что объясняют низким уровнем его проникновения через плаценту. Концентрации сертралина у плода составляют около 1/3 таковых в плазме крови матери. Сертралин создает самые низкие среди всех СИОЗС концентрации в молоке, и его применение сопряжено с низким риском развития неблагоприятных эффектов у ребенка, что позволяет рассматривать его в качестве препарата выбора для кормящих матерей. Таким образом, сертралин является одним из наиболее изученных СИОЗС, который обладает благоприятным профилем безопасности как для матери, так и для плода/новорожденного.

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