Individualización del tratamiento durante el embarazo en pacientes con trastorno bipolar: principales opciones terapéuticas

Autores/as

DOI:

https://doi.org/10.33448/rsd-v11i3.26058

Palabras clave:

Trastorno bipolar; El embarazo; Conducta en el tratamiento de drogas; Complicaciones del embarazo.

Resumen

Objetivo: Informar los resultados observados en el tratamiento de pacientes con Trastorno Afectivo Bipolar durante el embarazo. Metodología: Se trata de una investigación descriptiva del tipo revisión integradora. Se consideraron estudios publicados entre 2000 y 2022, obtenidos de bases de datos científicas que cubran fuentes relevantes inherentes al tema, utilizando como uno de los principales criterios la selección de artículos originales y actuales. En total, se analizaron 27 artículos que abordaban el tema. Resultados: El uso de litio debe hacerse con reservas, por el riesgo de defectos neurales en el feto, además del estrecho seguimiento de la litemia de la gestante. Los anticonvulsivantes también tienen riesgo de defectos neurales, además de la posibilidad de alteración en el metabolismo de los anticonceptivos, con riesgo de embarazo no deseado. Los antipsicóticos atípicos no presentan riesgo para el feto, excepto la risperidona. Los que tienen un perfil metabólico más alto, como la quetiapina y la olanzapina, tienen un mayor riesgo de desarrollar diabetes gestacional. Conclusión: O controle do humor de las pacientes con trastorno bipolar debe ser acompañado de forma competente pelo profesional de salud, que debe estar munido de todas las opciones terapéuticas, para que puedas presentar a las pacientes, obteniendo así una estrategia compartida y con mayores chances éxito.

Biografía del autor/a

Gustavo Silva Oliveira, Universidade Evangélica de Goiás

Graduando em medicina, Universidade Evangélica de Goiás, Anápolis-GO, Brasil

Rodolfo Lopes Vaz, Universidade Evangélica de Goiás

Graduando em medicina, Universidade Evangélica de Goiás, Anápolis-GO, Brasil

Lara Gomes Nery, Universidade Evangélica de Goiás

Graduanda em medicina, Universidade Evangélica de Goiás, Anápolis-GO, Brasil

Ana Cláudia Maia Mendonça Costa, Universidade Evangélica de Goiás

Graduanda em medicina, Universidade Evangélica de Goiás, Anápolis-GO, Brasil

Gabriela Ramos Ribeiro, Universidade Evangélica de Goiás

Graduanda em medicina, Universidade Evangélica de Goiás, Anápolis-GO, Brasil

Citas

Albertini, E., Ernst, C. L., & Tamaroff, R. S. (2019). Psychopharmacological Decision Making in Bipolar Disorder During Pregnancy and Lactation: A Case-by-Case Approach to Using Current Evidence. Focus (American Psychiatric Publishing), 17(3), 249–258. https://doi.org/10.1176/appi.focus.20190007

Ballester-Gracia, I., Pérez-Almarcha, M., Galvez-Llompart, A., & Hernandez-Viadel, M. (2019). Use of long acting injectable aripiprazole before and through pregnancy in bipolar disorder: a case report. BMC pharmacology & toxicology, 20(1), 52. https://doi.org/10.1186/s40360-019-0330-x

Cunha, L. C., Freire, R. V. C., Silva, C. M. S., Salazar, V. C. R., Cruz, A. C., Oliveira Neto, J. R., Almeida, R. F., & Pereira, I. B. (2021). Carbamazepina e carbamazepina-10, 11-epóxido de monitoramento de drogas terapêuticas e avaliação bioquímica e hematológica em pacientes ambulatoriais com transtorno bipolar. Research, Society and Development, 10(11), e377101119640. https://doi.org/10.33448/rsd-v10i11.19640

Dejong, K., Chatroux, L. R., Shields, M., & Caughey, A. B. (2018). 182: Pregnancy in patients with bipolar disorder: Maternal and neonatal outcomes. American Journal of Obstetrics and Gynecology, 218. DOI:10.1016/j.ajog.2017.10.059

Di Florio, A., Gordon-Smith, K., Forty, L., Kosorok, M. R., Fraser, C., Perry, A., Bethell, A., Craddock, N., Jones, L., & Jones, I. (2018). Stratification of the risk of bipolar disorder recurrences in pregnancy and postpartum. The British journal of psychiatry: the journal of mental science, 213(3), 542–547. https://doi.org/10.1192/bjp.2018.92

Dolman, C., Jones, I. R., & Howard, L. M. (2016). Women with bipolar disorder and pregnancy: factors influencing their decision-making. BJPsych open, 2(5), 294–300. https://doi.org/10.1192/bjpo.bp.116.003079

Freitas, M. S., Mendes, S. S., & Souza, J. C. P. (2021). O transtorno bipolar: senso comum x a visão psicopatológica. Research, Society and Development, 10(12), e547101220571. https://doi.org/10.33448/rsd-v10i12.20571

Imaz, M. L., Torra, M., Soy, D., García-Esteve, L., & Martin-Santos, R. (2019). Clinical Lactation Studies of Lithium: A Systematic Review. Frontiers in pharmacology, 10, 1005. https://doi.org/10.3389/fphar.2019.01005

Kameg B. N. (2021). Bipolar disorder: Treatment strategies for women of childbearing age. Perspectives in psychiatric care, 57(3), 1244–1249. https://doi.org/10.1111/ppc.12680

Khan, S. J., Fersh, M. E., Ernst, C., Klipstein, K., Albertini, E. S., & Lusskin, S. I. (2016). Bipolar Disorder in Pregnancy and Postpartum: Principles of Management. Current psychiatry reports, 18(2), 13. https://doi.org/10.1007/s11920-015-0658-x

Larsen, E. R., & Saric, K. (2017). Pregnancy and bipolar disorder: the risk of recurrence when discontinuing treatment with mood stabilisers: a systematic review. Acta neuropsychiatrica, 29(5), 259–266. https://doi.org/10.1017/neu.2016.60

Lorettu, L., Carpita, B., Nivoli, A., Milia, P., De Iorio, G., Cremone, I. M., & DellʼOsso, L. (2020). Lithium Use During Pregnancy in a Patient With Bipolar Disorder and Multiple Sclerosis. Clinical neuropharmacology, 43(5), 158–161. https://doi.org/10.1097/WNF.0000000000000407

Mota, A. L., Ricardo Neto, A., Figueiredo, B. Q., Araújo, I. de C., Oliveira, I. P., & Tafuri, N. F. (2021). Reações adversas decorrentes do tratamento com carbonato de lítio: uma revisão sistemática de literatura. Research, Society and Development, 10(11), e342101119853. https://doi.org/10.33448/rsd-v10i11.19853

Petkevicius, G. A. M., Roscoche, K. G. C., Soares, A. B. S., Sousa, A. A. S., Aguiar, A. S. C., & Felício, J. F. (2020). Perfil clínico – epidemiológico de pessoas com transtorno bipolar em internação psiquiátrica. Research, Society and Development, 9(9), e394997282. https://doi.org/10.33448/rsd-v9i9.7282

Previdelli, M. B., Spaziani, A. O., Barbosa, T. C., Rico, J. G., Custódio, I. A. D. L., Simioni, A. A. B., Frota, R. S., Santana, R. C. C., Azarias, M. M., Luz, O. R. M., Carvalho, M. M. L., Vidotti, M. Z., & Careno, A. D. A. S. (2020). Transtorno afetivo bipolar em paciente gestante com trágico desfecho fetal: relato de caso. Archives Of Health Investigation, 10(1), 38–41. https://doi.org/10.21270/archi.v10i1.4844

Rosso, G., Albert, U., Di Salvo, G., Scatà, M., Todros, T., & Maina, G. (2016). Lithium prophylaxis during pregnancy and the postpartum period in women with lithium-responsive bipolar I disorder. Archives of women's mental health, 19(2), 429–432. https://doi.org/10.1007/s00737-016-0601-0

Rusner, M., Berg, M., & Begley, C. (2016). Bipolar disorder in pregnancy and childbirth: a systematic review of outcomes. BMC pregnancy and childbirth, 16(1), 331. https://doi.org/10.1186/s12884-016-1127-1

Saito, T., Hersh, A. R., Garg B., Boone, R., & Caughey, A. B. (2020). Prenatal care attendance and pregnancy outcomes among women with bipolar disorder: a retrospective cohort study. American Journal of Obstetrics & Gynecology. Poster Session, 222 (1) supplement, S287-S288. DOI: https://doi.org/10.1016/j.ajog.2019.11.454

Sharma, V., Sharma, P., & Sharma, S. (2020). Managing bipolar disorder during pregnancy and the postpartum period: a critical review of current practice. Expert review of neurotherapeutics, 20(4), 373–383. https://doi.org/10.1080/14737175.2020.1743684

Stevens, A., Daggenvoorde, T. H., van der Klis, S., Kupka, R. W., & Goossens, P. (2018). Thoughts and Considerations of Women With Bipolar Disorder About Family Planning and Pregnancy: A Qualitative Study. Journal of the American Psychiatric Nurses Association, 24(2), 118–126. https://doi.org/10.1177/1078390317711251

Uguz F. (2017). Prophylactic use of olanzapine and quetiapine from pregnancy to the postpartum period in women with bipolar disorder: a case series. The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 30(21), 2569–2571. https://doi.org/10.1080/14767058.2016.1256991

Viguera, A. C., Nonacs, R., Cohen, L. S., Tondo, L., Murray, A., & Baldessarini, R. J. (2000). Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. The American journal of psychiatry, 157(2), 179–184. DOI:10.1176/APPI.AJP.157.2.179

Vladimirova, R., Stoyanova, V., & Milanova, V. (2016). Bipolar affective disorder, pregnancy and childbirth: clinical characteristics and heredity, Biotechnology & Biotechnological Equipment, 30:5, 976-983, DOI: 10.1080/13102818.2016.1208539

Wendt, A. C., Stamper, G., Howland, M., Cerimele, J. M., & Bhat, A. (2021). Indirect psychiatric consultation for perinatal bipolar disorder: A scoping review. General hospital psychiatry, 68, 19–24. https://doi.org/10.1016/j.genhosppsych.2020.11.011

Wesseloo, R., Liu, X., Clark, C. T., Kushner, S. A., Munk-Olsen, T., & Bergink, V. (2017). Risk of postpartum episodes in women with bipolar disorder after lamotrigine or lithium use during pregnancy: A population-based cohort study. Journal of affective disorders, 218, 394–397. https://doi.org/10.1016/j.jad.2017.04.070

Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs [Internet] 2005; 52(5), 546-53. https://doi.org/10.1111/j.1365-2648.2005.03621.x.

Wisner, K. L., Sit, D., O'Shea, K., Bogen, D. L., Clark, C. T., Pinheiro, E., Yang, A., & Ciolino, J. D. (2019). Bipolar disorder and psychotropic medication: Impact on pregnancy and neonatal outcomes. Journal of affective disorders, 243, 220–225. https://doi.org/10.1016/j.jad.2018.09.045

Yonkers, K. A., Wisner, K. L., Stowe, Z., Leibenluft, E., Cohen, L., Miller, L., Manber, R., Viguera, A., Suppes, T., & Altshuler, L. (2004). Management of bipolar disorder during pregnancy and the postpartum period. The American journal of psychiatry, 161(4), 608–620. https://doi.org/10.1176/appi.ajp.161.4.608

Publicado

18/02/2022

Cómo citar

OLIVEIRA, G. S. .; VAZ, R. L. .; NERY, L. G. .; COSTA, A. C. M. M.; RIBEIRO, G. R. .; ARRUDA, J. T. Individualización del tratamiento durante el embarazo en pacientes con trastorno bipolar: principales opciones terapéuticas. Research, Society and Development, [S. l.], v. 11, n. 3, p. e19811326058, 2022. DOI: 10.33448/rsd-v11i3.26058. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/26058. Acesso em: 17 jul. 2024.

Número

Sección

Ciencias de la salud