The fertility and fecundity of patients with psychoses

McGrath, John J.; Hearle, Jenny; Jenner, Linda; Plant, Karen M.; Drummond, Adriano; Barkla, J.

doi:10.1111/j.1600-0447.1999.tb00990.x

Cited by 140 publications

(89 citation statements)

References 11 publications

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“…2 Atypical antipsychotics in combination with lithium are also often prescribed to women of this age group. 2,4 Pregnancy and psychotropic treatment dilemma Although many women treated with psychotropic medication become pregnant or plan pregnancy, [9][10][11] no psychotropic medication has been licenced for use in pregnancy. 12,13 This leaves women and their health-care professionals in a treatment dilemma as they need to balance the health of the women with that of the unborn child.…”

Section: Introductionmentioning

confidence: 99%

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Petersen

McCrea

Sammon

et al. 2016

Health Technol Assess

132

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BackgroundAlthough many women treated with psychotropic medication become pregnant, no psychotropic medication has been licensed for use in pregnancy. This leaves women and their health-care professionals in a treatment dilemma, as they need to balance the health of the woman with that of the unborn child. The aim of this project was to investigate the risks and benefits of psychotropic medication in women treated for psychosis who become pregnant.Objective(s)(1) To provide a descriptive account of psychotropic medication prescribed before pregnancy, during pregnancy and up to 15 months after delivery in UK primary care from 1995 to 2012; (2) to identify risk factors predictive of discontinuation and restarting of lithium (multiple manufacturers), anticonvulsant mood stabilisers and antipsychotic medication; (3) to examine the extent to which pregnancy is a determinant for discontinuation of psychotropic medication; (4) to examine prevalence of records suggestive of adverse mental health, deterioration or relapse 18 months before and during pregnancy, and up to 15 months after delivery; and (5) to estimate absolute and relative risks of adverse maternal and child outcomes of psychotropic treatment in pregnancy.DesignRetrospective cohort studies.SettingPrimary care.ParticipantsWomen treated for psychosis who became pregnant, and their children.InterventionsTreatment with antipsychotics, lithium or anticonvulsant mood stabilisers.Main outcome measuresDiscontinuation and restarting of treatment; worsening of mental health; acute pre-eclampsia/gestational hypertension; gestational diabetes; caesarean section; perinatal death; major congenital malformations; poor birth outcome (low birthweight, preterm birth, small for gestational age, low Apgar score); transient poor birth outcomes (tremor, agitation, breathing and muscle tone problems); and neurodevelopmental and behavioural disorders.Data sourcesClinical Practice Research Datalink database and The Health Improvement Network primary care database.ResultsPrescribing of psychotropic medication was relatively constant before pregnancy, decreased sharply in early pregnancy and peaked after delivery. Antipsychotic and anticonvulsant treatment increased over the study period. The recording of markers of worsening mental health peaked after delivery. Pregnancy was a strong determinant for discontinuation of psychotropic medication. However, between 40% and 76% of women who discontinued psychotropic medication before or in early pregnancy restarted treatment by 15 months after delivery. The risk of major congenital malformations, and neurodevelopmental and behavioural outcomes in valproate (multiple manufacturers) users was twice that in users of other anticonvulsants. The risks of adverse maternal and child outcomes in women who continued antipsychotic use in pregnancy were not greater than in those who discontinued treatment before pregnancy.LimitationsA few women would have received parts of their care outside primary care, which may not be captured in this analysis. Likewise, the analyses were based on prescribing data, which may differ from usage.ConclusionsPsychotropic medication is prescribed before, during and after pregnancy. Many women discontinue treatment before or during early pregnancy and then restart again in late pregnancy or after delivery. Our results support previous associations between valproate and adverse child outcomes but we found no evidence of such an association for antipsychotics.Future workFuture research should focus on (1) curtailing the use of sodium valproate; (2) estimating the benefits of psychotropic drug use in pregnancy; and (3) investigating the risks associated with lifestyle choices that are more prevalent among women using psychotropic drugs.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

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Section: Introductionmentioning

confidence: 99%

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Petersen

McCrea

Sammon

et al. 2016

Health Technol Assess

132

View full text Add to dashboard Cite

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“…[2][3][4]9,11 In this study, the data show that the proportion of individuals who had been married was three times lower than that of the general population, regardless of gender.…”

Section: Discussionmentioning

confidence: 92%

“…[3][4][5]9 The fertility rate of female patients was two to three times lower than the fertility rate in the female population of the city of São Paulo. This result is not in agreement with the suggestion of other authors that women with schizophrenia would have an increased probability of becoming mothers, with fertilities rates similar to those found in the general population.…”

Section: 9mentioning

confidence: 99%

“…[6][7] However, subsequent studies have not confirmed this assumption. [3][4][5][8][9] Although schizophrenia has a relatively stable epidemiological profile in several countries, issues related to marriage and reproduction are subject to the influence of biological and socio-cultural factors.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] Due to the policy to reduce hospitalization and the improvements in pharmacological treatment the hypothesis that the deficit in reproductive rates for these patients might be reduced has been raised. [6][7] However, subsequent studies have not confirmed this assumption.…”

Section: Introductionmentioning

confidence: 99%

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Fertility and fecundity of an outpatient sample with schizophrenia

Terzian¹,

Andreoli²,

Razzouk³

et al. 2006

Rev. Bras. Psiquiatr.

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Fertility and fecundity of an outpatient sample with schizophrenia Fertilidade e fecundidade em uma amostra de pacientes ambulatoriais com esquizofrenia A b s t r a c t Objective: To determine reproductive rates among patients with schizophrenia who attended the outpatient clinic at the Universidade Federal de São Paulo. Method: All patients with schizophrenia completed a semi-standardized questionnaire, and data from the Brazilian census was used for comparing population rates. Results: 167 patients completed the questionnaires and of these 33 (19.8%) were or had been married and 32 reported being a parent. The fertility rate (number of individuals who had had at least one child divided by the total number of individuals) was 19.4% (25% for females, 15.8% for males, p = 0.14). Fecundity rate was 1.75 for males and 1.69 for females (p = 0.85). A logistic regression analysis identified an association between the later date of the onset of illness and higher rate of marriage (p = 0.003). Gender and the interaction between gender and marital status were significant predictors for fertility (p < 0.05 and p = 0.024, respectively). Conclusions: Patients with schizophrenia showed lower rates for marital status, fertility and fecundity when compared to standard population rates. However, many patients will become parents during their life time. Therefore, it is imperative to develop services that fulfill their needs, mainly in Brazil, a middle-income country, where resources are scarce and there is no policy for dealing with this reality.Descriptors: Schizophrenia; Reproductive behavior; Fertility; Gender identity; Outpatients

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