Use of Atypical Antipsychotics During Pregnancy and the Risk of Neural Tube Defects in Infants

University of Toronto, Toronto, Ontario, Canada
American Journal of Psychiatry (Impact Factor: 13.56). 02/2002; 159(1):136-7. DOI: 10.1176/appi.ajp.159.1.136
Source: PubMed

ABSTRACT Folate deficiency in early pregnancy and maternal adiposity, independent of folate intake, lead to a greater risk of neural tube defects in infants. Atypical antipsychotics cause various degrees of weight gain. The authors assessed folate status and obesity among patients with schizophrenia receiving atypical antipsychotics.
A sample of 70 inpatients and outpatients (21 of them women) who were taking antipsychotics was randomly selected. Body weight, body mass index, daily folate intake, and folate serum concentrations were determined.
The majority of the patients were overweight. Only eight of 37 patients had folate intake above 400 microg/day, the level shown to be protective against neural tube defects. Mean serum folate was significantly lower than in a general hospital group of 810 patients.
Women with schizophrenia who take atypical antipsychotics have a higher risk of neural tube defects in their infants because of the associated low intake of folate and obesity.

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    • "Medical records showed no history of gestational diabetes in our cases. There is a greater risk of development of neural tube defects in children born to women with schizophrenia who take atypicals because of the associated low intake of folate and obesity (Koren et al., 2002). We did not consider folic acid in this study because the first patient had normal levels of folic acid and we were not aware of pregnancy in the second patient. "
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    ABSTRACT: Stabilized patients who receive clozapine may wish to have children; but studies on pregnant women receiving clozapine treatment are limited. In this study, we report on clozapine use during pregnancy in two women. The first woman (Case 1) had two deliveries while she was receiving clozapine treatment for schizophrenia. Both her deliveries were term, uncomplicated vaginal deliveries, and the clozapine dose was reduced throughout pregnancy. The second woman (Case 2) developed schizophrenia after her first child was born. She became pregnant after clozapine initiation. She delivered twins by term, uncomplicated vaginal delivery. In our cases, no specific risks for the mothers and their children can be attributed to the use of clozapine. Physicians must be aware of the changes in fertility induced by prolactin-sparing drugs. Mothers who receive clozapine treatment should not be advised to breastfeed their children.
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    • "When the couple expressed the wish to have a second child they were fully informed regarding the risks-benefits of being maintained on her medication regimen. They decided to plan the pregnancy without discontinuing or reducing the medication and folate at a daily dose of 5 mg was added (Koren et al, 2002). "
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