The Use of Central Nervous System Active Drugs During Pregnancy

Abstract

CNS-active drugs are used relatively often during pregnancy. Use during early pregnancy may increase the risk of a congenital malformation; use during the later part of pregnancy may be associated with preterm birth, intrauterine growth disturbances and neonatal morbidity. There is also a possibility that drug exposure can affect brain development with long-term neuropsychological harm as a result. This paper summarizes the literature on such drugs used during pregnancy: opioids, anticonvulsants, drugs used for Parkinson’s disease, neuroleptics, sedatives and hypnotics, antidepressants, psychostimulants, and some other CNS-active drugs. In addition to an overview of the literature, data from the Swedish Medical Birth Register (1996–2011) are presented. The exposure data are either based on midwife interviews towards the end of the first trimester or on linkage with a prescribed drug register. An association between malformations and maternal use of anticonvulsants and notably valproic acid is well known from the literature and also demonstrated in the present study. Some other associations between drug exposure and outcome were found.

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

“…Other research on antipsychotic treatment in pregnancy includes pharmacovigilance studies from drug companies' safety databases 76,77 as well as cohort studies based on various data sources. 38,50,[78][79][80][81][82][83][84][85] A systematic review 19 of many of these studies suggested that women requiring antipsychotic treatment during pregnancy have a higher risk of adverse birth outcomes. However, there was substantial heterogeneity between the studies and Coughlin et al 19 emphasise that most studies had limited adjustment for potential confounding and therefore the observed associations may not be causal.…”

“…This has been the subject of a number of recent studies conducted in Europe and North America. [34][35][36][37][38][39][40][41] Epstein et al 39 examined use of psychotropic medication using data from Tennessee Medicaid to conduct a retrospective cohort study of nearly 300,000 women enrolled in the database throughout pregnancy from 1985 to 2005. This study reported significant increases in the use of anticonvulsants among mothers with pain and other psychiatric disorders, but a decrease in the use of lithium and typical antipsychotics.…”

“…23,38,48 However, these women may differ in terms of individual characteristics and health and lifestyle factors which can confound the associations between psychotropic drug treatment and the pregnancy and birth outcomes. To overcome some of these issues we compared women treated with psychotropic medication in pregnancy with those with records of psychotropic treatment before they became pregnant, but not in pregnancy, as well as with women who had no records of psychotropic treatment up to 24 months before and during pregnancy.…”

Neonatal Morbidity After Maternal Use of Antidepressant Drugs During Pregnancy

“…21 Mild sedatives (alimemazine, promethazine, propiomazine, and hydroxyzine) were classified separately from the neurotropic drugs.…”

Use of hypnotics in high risk patient groups

“…Studija rađena na animalnom uzorku takođe nije našla značajne malformacije u uzorku posle upotrebe diazepama, s tim da je uočeno da plod u ovom uzorki ima manju prosečnu telesnu težinu (animalni uzorci tipično dobijaju veće koncentracije leka u istraživanjima, u ovom slučaku ekvivalent od 240 mg diazepama po kilogramu telesne težine na dan) [10]. Bitno je napomenuti da je starija studija [11] koja je pratila efekte upotrebe diazepama kod trudnica našla povećanu verovatnoću pojave rasepa nepca kod ploda, ali kasnije studije ovo nisu potvrdile, ali su našle (u malom uzorku) češ-ću pojavu atrezije digestivnog trakta [12].…”