Use of Antipsychotics in the Management of Schizophrenia during Pregnancy

Abstract

The rapid development of pharmacotherapy has resulted in a growing clinical importance for the treatment of the increasing number of women with schizophrenia during pregnancy. An evolving database on reproductive health safety factors for women with schizophrenia has begun to be of assistance in optimising clinical benefits for women with childbearing potential. Given the prevalence of antipsychotic use during pregnancy in women with schizophrenia, it is important for the clinician to have a prepared approach to the administration of these agents. In general, the use of psychotropic medication during pregnancy is indicated when risk to the fetus from exposure to this medication is outweighed by the risks of untreated psychiatric illness in the mother. The preponderance of evidence from registries to large health surveys indicate that treatment with antipsychotic medication confers either no or a small nonspecific risk for organ malformations. According to the relevant literature published on the safety of antipsychotic medication during pregnancy, the findings are encouraging; however, the currently available data are very limited. Until there are more controlled prospective data on the impact of drugs on fetal and later development, the clinician will continue to work in a state of potential uncertainty, weighing partially estimated risks against managing individual clinical problems. The aim for the clinician should be to provide the best information available regarding the scope of possible risks associated with the treatment of schizophrenia during pregnancy. On the basis of the available data, generalisation is impossible and recommendations should be made on a drug-by-drug basis. The risks and benefits must always be carefully weighed for each patient on an individual basis. Only a woman who is well enough to acknowledge her pregnancy and her mental illness can effectively weigh the relative and partially unknown risks of treatment with antipsychotic medication against the highly probable risks of illness exacerbation if untreated.

The Emerging Importance of Transporter Proteins in the Psychopharmacological Treatment of the Pregnant Patient

“…Data indicate rates of depression during pregnancy rival those of nonpuerperal depression (Watson et al, 1984;Weissman and Olfson, 1995). Untreated women with psychoses neither improve during pregnancy nor require smaller maintenance doses of medication while pregnant (Gentile, 2004;Trixler and Tenyi, 1997;Trixler et al, 2005). Baldessarini and Viguera (1995) reported patients with schizophrenia are at greatest risk of relapse within the first 3 months following medication discontinuation.…”

“…As a result of this morbidity, about 35% of women take at least one psychoactive drug during their pregnancy (Trixler et al, 2005;Trixler and Teny, 1997). Fortunately, data on the successful and safe use of psychotropic medications to treat mental disorders during pregnancy are gradually accumulating and encouraging (Altshuler et al 1996;Cohen et al, 2006;Newport et al 2001).…”

Pharmacotherapy of obsessive-compulsive disorder during pregnancy: a clinical approach

“…In spite of this, very few well-controlled studies are available on its safety during pregnancy. 78,79 In a study of the Swedish Medical Birth Register, 72 the rate of congenital malformation was reported to be 2.6%, vs. 3.6% in a multicenter prospective-cohort study. 80 These rates are within the expected baseline risk for the general population.…”

Thérapeutique des troubles anxieux et dépressifs de la grossesse et du post-partum. Revue et synthèse

“…Aucune étude menée avec une méthodologie suffisamment fiable n'a montré de différence significative entre le comportement ou le quotient intellectuel des sujets exposés et une population comparable [88]. Cela contraste nettement avec les résultats obtenus avec les modèles animaux.…”