Antipsychotic Therapy During Early and Late Pregnancy. A Systematic Review. Schizophr Bull

Department of Mental Health ASL Salerno 1, Mental Health Center n. 4, Piazza Galdi, 841013 Cava de' Tirreni (Salerno), Italy.
Schizophrenia Bulletin (Impact Factor: 8.45). 10/2008; 36(3):518-44. DOI: 10.1093/schbul/sbn107
Source: PubMed


Both first- (FGAs) and second-generation antipsychotics (SGAs) are routinely used in treating severe and persistent psychiatric disorders. However, until now no articles have analyzed systematically the safety of both classes of psychotropics during pregnancy. DATA SOURCES AND SEARCH STRATEGY: Medical literature information published in any language since 1950 was identified using MEDLINE/PubMed, TOXNET, EMBASE, and The Cochrane Library. Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from companies developing drugs. Search terms were pregnancy, psychotropic drugs, (a)typical-first-second-generation antipsychotics, and neuroleptics. A separate search was also conducted to complete the safety profile of each reviewed medication. Searches were last updated on July 2008.
All articles reporting primary data on the outcome of pregnancies exposed to antipsychotics were acquired, without methodological limitations.
Reviewed information was too limited to draw definite conclusions on structural teratogenicity of FGAs and SGAs. Both classes of drugs seem to be associated with an increased risk of neonatal complications. However, most SGAs appear to increase risk of gestational metabolic complications and babies large for gestational age and with mean birth weight significantly heavier as compared with those exposed to FGAs. These risks have been reported rarely with FGAs. Hence, the choice of the less harmful option in pregnancy should be limited to FGAs in drug-naive patients. When pregnancy occurs during antipsychotic treatment, the choice to continue the previous therapy should be preferred.

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    • "To the Editor: Treatment of psychotic symptoms during pregnancy is mandatory since untreated mental illness can adversely impact the mothereinfant pair [1]. However, treatment of a pregnant mother with antipsychotics, the mainstay for schizophrenia treatment, is associated with increased risk for neonatal complications [1]. Transcranial Direct Current Stimulation (tDCS), a re-emerging brain stimulation technique with optimized application parameters , has been proposed as a safe treatment option for pregnant women with psychiatric disorders [2]. "

    Full-text · Article · Oct 2014 · Brain Stimulation
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    • "Antipsychotic medication is increasingly used by women of all ages [2], [17] for schizophrenia, bipolar disorder and a number of off-label indications such as depression, anxiety and borderline personality disorder [17], [18]. Multiple reviews have highlighted the lack of evidence regarding antipsychotic use in pregnancy and breastfeeding [19]–[24]. Whether antipsychotics exacerbate or mitigate the increased rate of stillbirth, prematurity, and obstetric complications seen in mothers with severe mental illness is unknown [25]–[27]. "
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    ABSTRACT: Many women diagnosed with varying psychiatric disorders take antipsychotic medications during pregnancy. The safety of antipsychotic medications in pregnancy is largely unknown. We established the National Register of Antipsychotic Medications in Pregnancy in 2005. Women who are pregnant and taking an antipsychotic medication are interviewed every 6 weeks during pregnancy and then followed until their babies are one year old. The baby's progress is closely followed for the first year of life. As of April 18 2012, 147 pregnancies had been followed through to completion. There were 142 live births and data is available for 100 one year old babies. 18% of babies were born preterm, with a higher dose of antipsychotic medication correlating to an increased likelihood of premature delivery; 43% of babies required special care nursery or intensive care after birth; 37% had any degree of respiratory distress and 15% of babies developed withdrawal symptoms. Congenital anomalies were seen in eight babies. Most pregnancies resulted in the birth of live, healthy babies. The use of mood stabilisers or higher doses of antipsychotics during pregnancy increased the likelihood of babies experiencing respiratory distress or admission to Special Care Nursery or Neonatal Intensive Care Units. There is a great need for safety and efficacy information about the use of antipsychotic medications in pregnancy. Live, healthy babies are the most common outcome following the use of antipsychotic medication in pregnancy, but clinicians should be particularly mindful of neonatal problems such as respiratory distress.
    Full-text · Article · May 2014 · PLoS ONE
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    • "Women with schizophrenia and bipolar disorder have a greater likelihood of complications, including placental abnormalities; hemorrhaging; fetal distress; congenital anomalies, such as cardiovascular defects; and neonatal complications [5]. Additionally, cessation of antipsychotic treatment for women with psychotic disorders may increase the risk of relapse, which in turn could lead to poor pre- and post-natal care as well as obstetric-related adverse events [4]. Therefore, clinicians and women must carefully weigh the benefits and the risks of remaining on or terminating antipsychotic treatment. "
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    ABSTRACT: Olanzapine use has been reported during pregnancy and breastfeeding, but there are no controlled clinical trials assessing the safety of olanzapine exposure to infants and fetuses. The purpose of this report was to review and analyze prospective post-marketing cases of pregnancy and breastfeeding with olanzapine, in order to guide clinicians and women on the use of olanzapine therapy during pregnancy and/or breastfeeding. A worldwide safety database maintained by Eli Lilly and Company was searched for all spontaneous-reported data regarding olanzapine use during pregnancy and/or breastfeeding. Cases reported prior to pregnancy outcome were considered to be prospective, and follow-up was pursued after the delivery date to assess outcome. Outcome data were available for 610 prospectively identified pregnancies during which olanzapine was used. The majority of women had normal births (66%), although premature births were reported in 9.8% and perinatal conditions in 8% of the pregnancies. A total of 102 pregnancies reported olanzapine treatment during breastfeeding. In these infants, the most commonly reported adverse events were somnolence (3.9%), irritability (2%), tremor (2%), and insomnia (2%), although the majority of pregnancies reported no adverse events (82.3%). The frequency of fetal outcomes in these prospectively identified pregnancies exposed to olanzapine did not differ from rates of outcomes reported in the general population. These data may be useful to help guide clinicians and women decide to continue, or discontinue, olanzapine therapy during pregnancy and/or breastfeeding, but should be considered within the limitations associated with spontaneously reported data. Women should notify their clinicians if they become pregnant or intend to become pregnant while being treated with olanzapine. Because of limited experience in humans, olanzapine should be used in pregnancy only when potential benefit justifies potential risk to the fetus. Olanzapine should only be considered during breastfeeding when the potential benefit justifies the potential risk to the infant.
    Full-text · Article · Aug 2013 · BMC pharmacology & toxicology
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