Desfechos gestacionais associados ao uso de antidepressivos na gestação de mulheres acompanhadas na atenção primária a saúde e busca experimental de uma alternativa medicamentosa

Abstract

The treatment of psychiatric disorders during pregnancy involves a comprehensive approach considering the risks and benefits for both the mother and the fetus. This study unfolded in two facets: the first, a quantitative and descriptive research conducted in humans aimed to assess the use of antidepressants by pregnant women and their potential impacts on childbirth. For this purpose, secondary data were collected from the medical records of pregnant women who underwent prenatal care in three healthcare units in a municipality in the South of Minas Gerais, from January 2019 to September 2022. Sociodemographic information, clinical/obstetric history, and details regarding delivery and the neonate were recorded. The collected data were transcribed and subjected to relevant analyses. The second facet of the study involved animal experimentation, aiming to conduct a comparative analysis of the effects of sertraline (SER) and venlafaxine (VEN) during mouse gestation and their consequences for both the mother and the offspring into adulthood. Female Swiss mice were divided into three experimental groups that received daily oral gavage of 20mg/kg/day of sertraline (GSER), 80mg/kg/day of venlafaxine (GVEN), while the control group (GC) received saline solution. The treatment commenced ten days before mating, during which the treatment's influence on the females' estrous cycle was assessed. Mating was conducted with males of the same lineage, and the first day of gestation (gd) was marked by the presence of the vaginal plug. Pregnancy resistance was evaluated, and pregnant females were euthanized on the 8th, 11th, and 15th gd for the analysis of uterine horns. In pregnancies carried to term, the offspring was standardized to eight pups, and their physical and neurological development was assessed. During the first month of life, the offspring underwent studies on memory, anxiety, depression, and socialization. It was observed that SER is among the most commonly used psychotropics, and this group of medications appears to have negative repercussions on anthropometric parameters and birth conditions in humans. In mice, treatment with SER resulted in longer estrous cycles, alterations in uterine horns such as hemorrhages and intrauterine growth restriction, alterations in placental weight, as well as reduced offspring weight at birth. VEN treatment resulted in alterations in placental weight. In behavioral tests, SER caused a decrease in social behavior. VEN was associated with anxiety-predictive behaviors in the offspring and increased exploration and sociability. Thus, based on the data from this study, it is concluded that antidepressant treatment leads to poorer gestational outcomes in humans, with SER being one of the most commonly used psychotropics. In the adopted experimental model, VEN showed a better risk-benefit ratio related to prenatal treatment compared to SER. However, when evaluating behavior, the anxiogenic effect of VEN on the offspring might be concerning. Therefore, it is concluded that further studies are necessary to assess other parameters related to the consequences of these treatments, as well as to explore new therapeutic alternatives.