Use of antipsychotics during pregnancy and their impact on congenital malformations and early neonatal adaptation
Authors:
K. Hrdličková 1,2
; H. Němcová 1,2
; A. Horáková 1,2
; A. Šebela 1,3
Authors‘ workplace:
Národní ústav duševního zdraví, Klecany
1; Katedra psychologie, FF UK, Praha
2; 3. LF UK, Praha
3
Published in:
Ceska Gynekol 2023; 88(3): 221-230
Category:
doi:
https://doi.org/10.48095/cccg2023221
Overview
Objective: Review of recent literature dealing with the effect of antipsychotic use during pregnancy on early postpartum adaptation of exposed infants and the development of congenital malformations. Results: The use of antipsychotics during pregnancy does not appear to lead to significantly higher risk of congenital malformations but may pose a greater risk for the early adaptation of the newborn (especially the risk of preterm birth and intensive care unit admission). The study to date face methodological limitations – lack of information on exact doses of antipsychotics, lack of control groups of women with psychiatric problems but not taking antipsychotics and failure to control for confounding factors. Conclusion: The available data suggest the relative safety of antipsychotics during pregnancy, provided that potential risks are known, and the woman and her baby are carefully monitored.
Keywords:
childbirth – Antipsychotics – newborn – pregnancy – congenital malformation
Sources
1. Apter G, Devouche E, Gratier M. Perinatal mental health. J Nerv Ment Dis 2011; 199 (8): 575–577. doi: 10.1097/NMD.0b013e318225f2f4.
2. Andrade SE, Raebel MA, Brown J et al. Use of antidepressant medications during pregnancy: a multisite study. Am J Obstet Gynecol 2008; 198 (2): 194.e1–194.e5. doi: 10.1016/ j.ajog.2007.07.036.
3. Riska BS, Skurtveit S, Furu K et al. Dispensing of benzodiazepines and benzodiazepine-related drugs to pregnant women: a population-based cohort study. Eur J Clin Pharmacol 2014; 70 (11): 1367–1374. doi: 10.1007/s00228-014-1744-4.
4. Taylor CL, Broadbent M, Khondoker M et al. Predictors of severe relapse in pregnant women with psychotic or bipolar disorders. J Psychiatr Res 2018; 104: 100–107. doi: 10.1016/j.jpsychires.2018.06.019.
5. Viguera AC, Whitfield T, Baldessarini RJ et al. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatry 2007; 164 (12): 1817–1923. doi: 10.1176/appi.ajp.2007.06101639.
6. Raha S, Taylor VH, Holloway AC. Effect of atypical antipsychotics on fetal growth: is the placenta involved? J Pregnancy 2012; 2012: 315203. doi: 10.1155/2012/315203.
7. Newport DJ, Calamaras MR, DeVane CL et al. Atypical antipsychotic administration during late pregnancy: placental passage and obstetrical outcomes. Am J Psychiatry 2007; 164 (8): 1214–1220. doi: 10.1176/appi.ajp.2007.061 11886.
8. Onken M, Mick I, Schaefer C. Paliperidone and pregnancy-an evaluation of the German Embryotox database. Arch Womens Ment Health 2018; 21 (6): 657–662. doi: 10.1007/s00737-018-0828-z.
9. Bellet F, Beyens MN, Bernard N et al. Exposure to aripiprazole during embryogenesis: a prospective multicenter cohort study. Pharmacoepidemiol Drug Saf 2015; 24 (4): 368–380. doi: 10.1002/pds.3749.
10. Cohen LS, Góez-Mogollón L, Sosinsky AZ et al. Risk of major malformations in infants following first-trimester exposure to quetiapine. Am J Psychiatry 2018; 175 (12): 1225–1231. doi: 10.1176/appi.ajp.2018.18010098.
11. Cohen LS, Viguera AC, McInerney KA et al. Reproductive safety of second-generation antipsychotics: current data from the massachusetts general hospital national pregnancy registry for atypical antipsychotics. Am J Psychiatry 2016; 173 (3): 263–270. doi: 10.1176/appi.ajp.2015.15040506.
12. Sadowski A, Todorow M, Yazdani Brojeni P et al. Pregnancy outcomes following maternal exposure to second-generation antipsychotics given with other psychotropic drugs: a cohort study. BMJ Open 2013; 3 (7): e003062. doi: 10.1136/bmjopen-2013-003062.
13. Hatters Friedman S, Moller-Olsen C, Prakash C et al. Atypical antipsychotic use and outcomes in an urban maternal mental health service. Int J Psychiatry Med 2016; 51 (6): 521–533. doi: 10.1177/0091217417696739.
14. Habermann F, Fritzsche J, Fuhlbrück F et al. Atypical antipsychotic drugs and pregnancy outcome: a prospective, cohort study. J Clin Psychopharmacol 2013; 33 (4): 453–462. doi: 10.1097/JCP.0b013e318295fe12.
15. Ellfolk M, Leinonen MK, Gissler M et al. Second-generation antipsychotic use during pregnancy and risk of congenital malformations. Eur J Clin Pharmacol 2021; 77 (11): 1737–1745. doi: 10.1007/s00228-021-03169-y.
16. Huybrechts KF, Hernández-Díaz S, Patorno E et al. Antipsychotic use in pregnancy and the risk for congenital malformations. JAMA Psychiatry 2016; 73 (9): 938–946. doi: 10.1001/jamapsychiatry.2016.1520.
17. Petersen I, Sammon CJ, McCrea RL et al. Risks associated with antipsychotic treatment in pregnancy: comparative cohort studies based on electronic health records. Schizophr Res 2016; 176 (2–3): 349–356. doi: 10.1016/ j.schres.2016.07.023.
18. Montastruc F, Salvo F, Arnaud M et al. Signal of fastrointestinal congenital malformations with antipsychotics after minimising competition bias: a disproportionality analysis using data from bigibase (®). Drug Saf 2016; 39 (7): 689–696. doi: 10.1007/s40264-016-0413-1.
19. Heinonen E, Forsberg L, Nörby U et al. Neonatal morbidity after fetal exposure to antipsychotics: a national register-based study. BMJ Open 2022; 12 (6): e061328. doi: 10.1136/bmj open-2022-061328.
20. Frayne J, Nguyen T, Bennett K et al. The effects of gestational use of antidepressants and antipsychotics on neonatal outcomes for women with severe mental illness. Aust N Z J Obstet Gynaecol 2017; 57 (5): 526–532. doi: 10.1111/ajo.12621.
21. Nguyen T, Frayne J, Watson S et al. Long-acting injectable antipsychotic treatment during pregnancy: outcomes for women at a tertiary maternity hospital. Psychiatry Res 2022; 313: 114614. doi: 10.1016/j.psychres.2022.114614.
22. Kulkarni J, Worsley R, Gilbert H et al. A prospective cohort study of antipsychotic medications in pregnancy: the first 147 pregnancies and 100 one year old babies. PLoS One 2014; 9 (5): e94788. doi: 10.1371/journal.pone.0094788.
23. Peng M, Gao K, Ding Y et al. Effects of prenatal exposure to atypical antipsychotics on postnatal development and growth of infants: a case-controlled, prospective study. Psychopharmacology (Berl) 2013; 228 (4): 577–584. doi: 10.1007/s00213-013-3060-6.
24. Vigod SN, Gomes T, Wilton AS et al. Antipsychotic drug use in pregnancy: high dimensional, propensity matched, population based cohort study. BMJ 2015; 350: h2298. doi: 10.1136/bmj.h2298.
25. Bodén R, Lundgren M, Brandt L et al. Antipsychotics during pregnancy: relation to fetal and maternal metabolic effects. Arch Gen Psychiatry 2012; 69 (7): 715–721. doi: 10.1001/archgenpsychiatry.2011.1870.
26. Michielsen LA, van der Heijden FM, Janssen PK et al. Effects of maternal psychotropic drug dosage on birth outcomes. Neuropsychiatr Dis Treat 2014; 10: 13–18. doi: 10.2147/NDT.S53430.
27. Grzeskowiak LE, Gilbert AL, Morrison JL. Exposed or not exposed? Exploring exposure classification in studies using administrative data to investigate outcomes following medication use during pregnancy. Eur J Clin Pharmacol 2012; 68 (5): 459–467. doi: 10.1007/s00 228-011-1154-9.
28. Englerová K, Takács L. Prenatální, perinatální a neonatální faktory a jejich vliv na školní úspěšnost u dětí mladšího školního věku. Ceska Gynekol 2020; 85 (1): 71–79.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
2023 Issue 3
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