Antipsychotic use in pregnancy

Abstract

Given the potential harm of not treating severe psychiatric illnesses during pregnancy, careful administration of antipsychotics is recommended for pregnant women who suffer from severe mental disorders. The most frequently used antipsychotics in pregnancy are olanzapine, risperidone and quetiapine, and do not appear to cause consistent, congenital harm to the fetus. No specific patterns of fetal limb or organ malformation related to these drugs have been reported. There is some evidence suggesting an association between antipsychotic use in pregnancy and the development of gestational diabetes. Also there appears to be an association between antipsychotic medication use in pregnancy and increased neonatal respiratory distress and withdrawal symptoms. Further studies are needed for clinicians to balance good maternal mental health, healthy pregnancies and good infant health outcomes.

Antidepressants, Antipsychotics, and Mood Stabilizers in Pregnancy: What Do We Know and How Should We Treat Pregnant Women with Depression

“…In the evaluation of individual agents, a small increased risk in overall malformations (RR, 1.26; 95% CI, 1.02–1.56) and cardiac malformations (RR, 1.26; 95% CI, 0.88–1.81) was found for risperidone that was independent of confounders (Huybrechts et al, ). A similar slight increase in the rate of congenital anomalies following prenatal risperidone was also observed in other much smaller studies, with a total of 79 pregnancies (Habermann et al, ; Kulkarni et al, ).…”

“…The Australian national register of antipsychotic drugs in pregnancy reported respiratory distress among 37% of 142 neonates exposed to antipsychotics. However, respiratory symptoms were six times more common than in controls following concomitant exposure to mood stabilizers (Kulkarni et al, ). Poor birth outcomes were found in 31 of 290 (10.7%) pregnancies in a U.K. cohort, which was double the rate (24/492 [4.9%]) in women with antipsychotic therapy only before pregnancy and nearly triple the rate (9244/210,966 [4.4%]) of controls, with no history of antipsychotic therapy.…”

Patterns and predictors for prescription of psychotropics and mood‐stabilizing antiepileptics during pregnancy in Denmark 2000–2016

“…While there is reasonably consensus that antidepressants (ADs), specifically selective serotonin re‐uptake inhibitors (SSRIs), are unlikely to pose a substantial risk to the unborn child , controversy remains on certain specific issues, not least the hypothesized impact on childhood neurodevelopment . For antipsychotic drugs (APs), the amount of data is less impressive, and the amount of safety data available has been lagging the transition from usage patterns from first‐generation antipsychotics (FGAPs) to second‐generation antipsychotics (SGAPs) . During the last 5 years, a substantial amount of safety data has emerged for the SGAP olanzapine and quetiapine especially , while data for other SGAP remain relatively scarce .…”

Use of Paliperidone Palmitate Throughout a Schizoaffective Disorder Patient’s Gestation Period

“…These results suggest that it would be unlikely for second-generation antipsychotics to increase the risk of major malformations above 10-fold beyond that observed in the general population or among control groups using other psychotropic medications. As presented by Kulkarni et al [11] therefore, given the potential harm of not treating severe psychiatric illnesses during pregnancy, careful administration of antipsychotics is recommended for pregnant women who suffer from severe mental disorders.…”