Use of atypical antipsychotics during pregnancy and the risk of neural tube defects in infants
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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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.Journal of Psychopharmacology 02/2008; 22(1):111-3. DOI:10.1177/0269881107079171 · 2.81 Impact Factor
- Archives of Women s Mental Health 06/2006; 9(3):158-9. DOI:10.1007/s00737-006-0126-z · 1.96 Impact Factor
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ABSTRACT: Die meisten Medikamente sind nicht für die Anwendungen in der Schwangerschaft zugelassen. Trotzdem setzen einige Frauen die Behandlung mit Psychopharmaka in der Schwangerschaft fort. Das relative Risiko und der Nutzen der Behandlung müssen für diese Patientinnen abgewogen werden, und die Behandlung sollte nur dann erfolgen, wenn der Benefit der Behandlung das Risiko übersteigt. Das Risiko beinhaltet Teratogenität, neonatale Toxizität, Auswirkungen auf den Schwangerschaftsverlauf und Entwicklungsdefizite des Kindes. Eine koordinierte Behandlung ist unabdingbar und bezieht die betroffene Frau, ihren Partner und GynäkologIn mit ein. Eine sorgfältige Dokumentation der Behandlung ist notwendig. Alle im ersten Trimenon mit Psychopharmaka behandelten Frauen sollten entweder an ein Register der Firma oder an das Embryotoxikologiezentrum (www.frauen-psychiatrie.de) gemeldet werden. Dies ermöglicht rasch ausreichend hohe prospektive Fallzahlen zu generieren und macht somit für uns alle Entscheidungen in Zukunft leichter. Most drugs are not labeled for use in pregnancy. Although psychotropic drugs have not been tested or approved for use during pregnancy, some women continue to take these medications while they are pregnant. The relative risks and benefits of drug therapy for these women must be weighed with each patient and treatment limited to those situations in which risks to mother and fetus from the disorder are presumed to exceed the risk of drug treatment. Risks of psychotropic drug use during pregnancy include teratogenic effects, direct neonatal toxicity, influence on pregnancy and the potential for longer-term neurobehavioral sequelae. Coordination of care with the patient, her partner, and the obstetrician is essential, as is careful medical record documentation when treating pregnant patients with psychiatric disorders. It is important that health care providers report all first trimester exposures to registries from pharmaceutical companies or embryo toxicology centers (www.frauen-psychiatrie.de) in order to help gather prospective data, which will make decisions easier for all of us.Psychiatrie und Psychotherapie 11/2005; 1(1):17-24. DOI:10.1007/s11326-005-0004-8