Trastorno Límite de la Personalidad, Policonsumo y Vulnerabilidad Psicosocial en el Embarazo: Revisión Narrativa y Propuesta de Protocolo Clínico
Resumen
Introducción: el trastorno límite de la personalidad (TLP) durante la gestación representa un escenario clínico complejo, potenciado por la frecuente comorbilidad con el policonsumo y la alta vulnerabilidad psicosocial. Métodos: se realizó una revisión narrativa de la literatura científica (1995–2024) en bases de datos como PubMed, SciELO y Google Académico. Se incluyeron 174 referencias entre estudios clínicos, revisiones y guías sobre TLP, embarazo, consumo de sustancias y salud mental perinatal. Resultados: las gestantes con TLP presentan tasas elevadas de embarazo no planificado y ausencia de redes de apoyo estables. Hasta el 78 % desarrolla un trastorno adictivo a lo largo de la vida; entre un 33 % y 50 % incurre en policonsumo activo. Estas condiciones se asocian con mayor riesgo obstétrico: parto pretérmino (OR 1.54), preeclampsia (17.4 % vs. 8.8 % en controles), corioamnionitis (OR 1.65), cesárea (OR 1.44) y rotura prematura de membranas (OR 1.4). El 21 % de los neonatos requiere ingreso a UCIN; hasta el 84 % desarrolla apego inseguro. Se documentan alteraciones epigenéticas (hipermetilación de NR3C1), neuroanatómicas (↓volumen frontal, ↑amígdala) y disfunciones ejecutivas en la madre. Discusión: se propone un protocolo clínico escalonado con cribado universal en atención primaria (ASSIST, K10, BSL-23), derivación a unidades especializadas y abordajes integrados en contextos de alta complejidad. Incluye psicoterapia adaptada (DBT, MBT, STEPPS), farmacoterapia segura (sertralina, quetiapina, lamotrigina), y estrategias de reducción de daños. El modelo busca mejorar la adherencia, reducir la morbilidad materno-fetal y cortar el ciclo intergeneracional de la psicopatología.
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Derechos de autor 2026 Carlos Armando Herrera-Huerta , Christian Antonio Saldivar-Tapia , Lucía del Carmen Márquez Avilez, César Dalí González Gastélum, Enrique Camarena Robles, Pedro Moreno Gea, Ana Irais Becerra Durand
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
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