Case Report: Clozapine use in two women with schizophrenia during pregnancy

Duran, Alaattin; Uğur, Müfit; Turan, Şenol; Emül, Murat

doi:10.1177/0269881107079171

Cited by 19 publications

(11 citation statements)

References 14 publications

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“…Our results were consistent with some case reports and few studies [ 8 , 12 ], but not others [ 5 – 7 ]. Mendhekar [ 13 ] reported that an infant had delayed speech acquisition until 5 years old when the mother was taking clozapine during pregnancy and breast feeding period, but in our study we did not find any difference for language development between the two groups.…”

Section: Discussionsupporting

confidence: 94%

“…However, there is sparse data on the reproductive safety of the currently available newer compounds. Up to now, most information about atypical antipsychotics on reproductive safety and the effects on infant development come from case reports, case series, and retrospective studies [ 5 – 7 ]. Very few studies compared the difference effects on infants’ development for clozapine and other atypical antipsychotics.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Clozapine and other Atypical Antipsychotics on Infants Development Who Were Exposed to as Fetus: A Post-Hoc Analysis

Shao

Peng

et al. 2015

PLoS ONE

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ObjectiveTo investigate the developmental effects of clozapine and other atypical antipsychotics on infants who were exposed to as fetus.MethodThe developmental progress of 33 infants who were exposed to clozapine as fetus was compared to 30 infants who were exposed to risperidone, olanzapine or quetiapine as fetus by assessing Apgar scoring, birth weight at birth, body weight, height, and the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) at months 2, 6 and 12 of age. Five subscale scores of BSID-III including cognitive, language, motor, social-emotional, and adaptive behavior were also compared. Student’s t test and Chi-square analysis were used as appropriate. Repeated measurements were evaluated by analysis of covariance.ResultsOf the 63 infants, 58 (92.1%) completed a 12-month study period. At the age of 2 and 6 months, mean adaptive behavior scores of BSID-III were significantly lower in clozapine-exposed infants than infants who exposed to other atypical antipsychotic at 2 and 6 months of age. More clozapine-exposed infants had delayed development (defined as the subscale score of <85) for adaptive behavior at 2 and 6 months of age. There was no difference between the two groups for cognitive, language, motor, social and emotional at 2, 6 and 12 months of age. More infants who were exposed to clozapine as fetus (25 of 33, 75.8%) had disturbed sleep and a labile state than those who were exposed to other atypical antipsychotics (8 of 30, 26.7%) during 2 months of age (P<0.001).ConclusionThese results suggest that clozapine has more adaptive behavior effects on infants who were exposed to as a fetus than other atypical antipsychotics at 2 and 6 months of age.Trial RegistrationClinicalTrials.gov NCT01479400

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Effects of Clozapine and other Atypical Antipsychotics on Infants Development Who Were Exposed to as Fetus: A Post-Hoc Analysis

Shao

Peng

et al. 2015

PLoS ONE

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“…However, it was not possible to conclude whether this neurodevelopmental difficulty was due to the use of clozapine or other factors. Others case reports on clozapine use during pregnancy have reported no complications or congenital anomalies [57,58]. concluded that exposure to risperidone does not increase pregnancy risks compared with those in women not taking the drug [50].…”

Section: Treatment During Pregnancymentioning

confidence: 99%

Section: Special Considerations During Pregnancy and The Postpartum Periodmentioning

confidence: 99%

Bipolar Disorder Differences between Genders: Special Considerations for Women

Vega

Barbeito

Azúa

et al. 2011

Womens Health (Lond Engl)

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The objective of this article is to review clinical differences between men and women with bipolar disorder. The secondary objective is to analyze the differences in adherence to medication between genders. Men usually present with manic episodes and have comorbid drug abuse, while women usually present with major depressive episode, the onset is often later, comorbidity of physical pathology is common and adherence to medication is greater than in men. In women who have an earlier onset of the illness and are single, the risk of nonadherence is higher than in other groups of women. There are two time periods that are very important in women: pregnancy and postpartum. Both are critical periods and a relapse or recurrence of symptoms at either stage can have serious consequences for the woman and/or her baby. In addition, the effect of medication on the fetus is unclear. In conclusion, there is a clear need for more studies on gender differences in bipolar disorder and how to improve adherence to treatment. Moreover, a better understanding of how to treat women with bipolar disorder during pregnancy and lactation will undoubtedly lead to improved outcomes for both the mother and her child.

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“…Gestational diabetes mellitus, neonatal seizures, neonatal agranulocytosis, macrocephaly, shoulder dystocia, floppy infant syndrome, decrease foetal heart rate variability, atrial septum defect, gastroesophageal problems, and delayed peristalsis have been reported to have adverse outcomes in maternal exposure to clozapine during pregnancy [11][12][13][14][15][16][17][18][19][20]. On the other hand, some studies have reported that no adverse effects were found in the newborns [21][22][23]. Pregnancy period is not protective for schizophrenia, unlike may lead to relapse of a patient in remission.…”

Section: Discussionmentioning

confidence: 99%

Neurodevelopmental and growth follow-up of the baby exposed to antipsychotics during pregnancy and lactation: a case report

Uygur

2019

Psychiatry and Clinical Psychopharmacology

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Clozapine is an antipsychotic drug for the treatment-resistant schizophrenia. Although clozapine is superior to other antipsychotics, it is less common in psychiatric prescriptions due to clozaphobia. Little is known about the use of clozapine during pregnancy and lactation, or its effect on the mother, foetus and baby. Pregnancy category of clozapine is considered to be of relatively reliable category B, while it is recommended to be avoided during breastfeeding. Switching from clozapine to other antipsychotics during breastfeeding may lead to psychotic exacerbations. In this case, low dose of clozapine may need to be added to the antipsychotic treatment initiated during breastfeeding. However, data on the safety of combination antipsychotics during breastfeeding are limited. Psychiatrists, obstetricians and pediatricians should closely monitor with team spirit on such cases, thus drug exposure and side effects of infant are minimized while the mother's mental health is maintained. We aimed to present the growth and neurodevelopmental outcomes of infant exposed to clozapine during pregnancy and exposed to clozapine plus olanzapine during the lactation period.

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Case Report: Clozapine use in two women with schizophrenia during pregnancy

Cited by 19 publications

References 14 publications

Effects of Clozapine and other Atypical Antipsychotics on Infants Development Who Were Exposed to as Fetus: A Post-Hoc Analysis

Effects of Clozapine and other Atypical Antipsychotics on Infants Development Who Were Exposed to as Fetus: A Post-Hoc Analysis

Bipolar Disorder Differences between Genders: Special Considerations for Women

Neurodevelopmental and growth follow-up of the baby exposed to antipsychotics during pregnancy and lactation: a case report

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