Antipsychotics In Pregnancy Research Articles

Antipsychotic utilization patterns in pregnant women with psychotic disorders: a 16-year population-based cohort study.

Despite growing concern about reproductive safety of antipsychotics, there is a paucity of research specifically assessing prenatal antipsychotic prescribing practices for psychotic disorders. This population-based cohort study identified women aged 15-50years with diagnosis of psychotic disorders, who delivered their first and singleton child between 2003-2018 in Hong Kong, with an aim to examine temporal trends and predictors of prenatal antipsychotic use as well as antipsychotic utilization patterns before and during pregnancy. Data were retrieved from territory-wide medical-record database of public healthcare services. Of 804 women, 519 (65%) redeemed at least one prescription for antipsychotics during pregnancy. Older age at conception (25-34years: OR 2.12 [95% CI 1.22-3.67]; 35-50years: 2.52 [1.38-4.61]; 15-24years as reference category) and antipsychotic treatment within 12months pre-pregnancy (24.22 [16.23-36.16]) were significantly associated with prenatal antipsychotic use. Second-generation-antipsychotic (SGA) use during pregnancy increased over 16-year study period, while prenatal first-generation-antipsychotic (FGA) use showed declining trend. Overall antipsychotic and SGA use progressively decreased across pre-pregnancy and trimesters of pregnancy. Further analyses on antipsychotic use trajectories revealed that 87.4% (n = 459) of 529 women receiving antipsychotics in 12-month pre-pregnancy redeemed antipsychotic prescription during pregnancy, and 63.4% (n = 333) continued antipsychotic treatment throughout pregnancy. Only 7.5% of the cohort (n = 60) commenced antipsychotics in pregnancy. This is one of the few studies evaluating real-world prenatal antipsychotic utilization among women with psychotic disorders. Future research delineating risk conferred by illness-related factors and antipsychotic exposure on adverse maternal and fetal outcomes is warranted to facilitate treatment guideline development.

Long-Acting Injectable Antipsychotic Medications in Pregnancy: A Review.

Long-acting injectable antipsychotic medications (LAIs) are an evidence-based treatment option for people with severe mental illness. While women with severe mental illness who are prescribed LAIs can become pregnant, there is a dearth of research examining the safety of these medication formulations during pregnancy. This article summarizes available literature on the use of LAIs in pregnancy to help inform clinical decisions and guide future research. PubMed literature searches were completed using combinations of keywords including "antipsychotic" and "long-acting injectable" or "depot," or generic or brand names of LAIs with "pregnancy." Pregnancy outcomes were compared across studies. Twelve relevant case reports of 13 pregnancies were identified. Six cases did not report any negative birth or infant outcomes, including prematurity, infants being born small for gestational age, congenital anomalies, and extrapyramidal symptoms. No cases reported abnormal Apgar scores, infants being born large for gestational age, or negative long-term developmental outcomes after exposure to LAIs during pregnancy. Cesarean section rate was comparable to the general population. Specific adverse outcomes included one infant with multiple congenital anomalies, 3 infants with minor congenital anomalies, and one infant with possible extrapyramidal symptoms. One infant was born prematurely, one infant was born small for gestational age, and 2 infants were born both prematurely and small for gestational age. There is little research specifically examining the use of LAIs in pregnancy, so risks must be extrapolated from studies on oral antipsychotics in pregnancy. While the few published case reports examining LAIs in pregnancy somewhat align with research examining oral antipsychotics, these findings are inconclusive due to the inherently limited nature of case reports. Further investigation into the use of LAIs in pregnancy is warranted.

Schizophrenia during pregnancy.

A diagnosis of schizophrenia has significant implications for women of childbearing age, pregnant or considering a pregnancy, ranging from sexual health, psychopharmacological treatment, to the occurrence of negative pregnancy and foetal outcomes. We provide a short narrative review of recent papers focusing on these issues. Although pregnancy rates have been increasing in women with a diagnosis of schizophrenia, they also tend to have altogether fewer pregnancies and fewer live births than women without this diagnosis, and also higher rates of induced abortions.Use of antipsychotics in pregnancy has also increased, and evidence suggests lack of significant contraindications for their use in this period. However, drug levels monitoring may be recommended across the three trimesters, as levels may change in relation to pregnancy-related physiology.Monitoring of physical health is an increasingly crucial issue, given higher risk of gestational diabetes, negative obstetric and infant outcomes in these women. There is an urgent need to generate valid and reproducible research that could help implement appropriate treatment protocols and relapse-prevention approaches, and interventions based on strong pharmaceutical targets for the benefit of pregnant women with a diagnosis of schizophrenia, their families and their children.

Antipsychotics in pregnancy: balancing between risks of untreated illness and risks of drug-related adverse effects

Antipsychotics in pregnancy: balancing between risks of untreated illness and risks of drug-related adverse effects

Use of Antipsychotic Drugs During Pregnancy

Antipsychotics are frequently prescribed to women of childbearing age and are increasingly prescribed during pregnancy. A small, but growing, body of research on implications for pregnancy and infant outcomes is available to inform the risks and benefits of in utero exposure to antipsychotics. This review examines the existing published research on the use of common typical and atypical antipsychotics in pregnancy and the implications for pregnancy and infant outcomes. The majority of studies do not show associations with major malformations and antipsychotic use in pregnancy, with the possible exception of risperidone. There is concern that atypical antipsychotics may be associated with gestational diabetes. Metabolic changes during pregnancy may necessitate dose adjustments. In general, it is recommended that women who need to take an antipsychotic during pregnancy continue the antipsychotic that has been most effective for symptom remission. Further study on risperidone is needed to better understand its association with malformations and it is not considered a first-line agent for use during pregnancy.

Treatment With Antipsychotics in Pregnancy: Changes in Drug Disposition.

Although pregnancy is known to cause changes in drug pharmacokinetics, little is known about its impact on serum levels of antipsychotics. In this study we retrospectively assessed 201 routine serum antipsychotic therapeutic drug monitoring concentration measurements obtained from a total of 110 pregnancies in 103 women, and 512 measurements from the same women before and after pregnancy. Serum concentrations in the third trimester were significantly lower than baseline for quetiapine (−76%; confidence interval (CI), −83%, −66%; P < 0.001) and aripiprazole (−52%; CI, −62%, −39%; P < 0.001), but not for olanzapine (−9%; CI, −28%, +14%; P = 0.40). For the remaining antipsychotics (perphenazine, haloperidol, ziprasidone, risperidone, and clozapine), our dataset was limited, but it indicates that concentrations may decline at least for perphenazine and possibly also for haloperidol. Even though the clinical consequence of the serum concentrations decline remains to be elucidated, our results warrant close clinical monitoring throughout pregnancy, preferentially supported by therapeutic drug monitoring.

Use of atypical antipsychotics in pregnancy and maternal gestational diabetes

BackgroundSecond generation antipsychotic medications (SGAs) are widely used by reproductive-age women to treat a number of psychiatric illnesses. Some SGAs have been associated with an increased risk of developing diabetes, although information regarding their diabetogenic effect in pregnant women is scarce. ObjectiveTo evaluate the risk of gestational diabetes (GDM) among women treated with SGA. MethodThe Massachusetts General Hospital (MGH) National Pregnancy Registry for Atypical Antipsychotics (NPRAA) collects data on drug use, pregnancy outcomes, and other characteristics from pregnant women, ages 18–45 years, using 3 phone interviews conducted at (1) enrollment during pregnancy, (2) 7 months' gestation, and (3) 2–3 months postpartum. Information on GDM was abstracted from obstetric and delivery medical records. The study population was restricted to women without pre-gestational diabetes. Pregnancies exposed to SGAs during the first trimester were compared with a reference group of women with psychiatric conditions but not treated with SGAs during pregnancy. Generalized linear models were used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for GDM. ResultsOf 303 women exposed to SGAs, 33 (10.9%) had GDM compared to 16 (10.7%) in the 149 non-exposed women. The crude OR of GDM for SGA was 1.02 (95% CI, 0.54–1.91). After adjustment for maternal age, race, marital status, employment status, level of education, smoking, and primary psychiatric diagnosis, the OR moved to 0.79 (0.40–1.56). ConclusionsFindings did not suggest an increased risk of GDM associated with exposure to SGAs during pregnancy in women who had used SGA before pregnancy without developing diabetes, compared to psychiatrically ill women who were not exposed to SGA. Trial RegistrationClinicalTrials.gov identifier: NCT01246765.

Psychopharmacological treatment of schizophrenia during pregnancy and lactation.

It is necessary, in every-day clinical life when treating pregnant women with mental diseases, to reach quick decisions derived from recent comprehensive information. The knowledge of the use of antipsychotics in pregnancy has increased considerably in the last years. This review tries to summarize important considerations and facilitate clinical decisions. This review will cover not only the effects of exposure during pregnancy on outcomes, postnatal adaption syndrome and lactation, but also pharmacokinetic considerations on the use of antipsychotics during pregnancy. The recent publications have found only minimally increased risks for certain malformations, after using ever more sophisticated statistical models of analysis and reassuring amounts of data. Taken together, the quality of the studies has greatly improved and the results are reassuring with respect to the safety of the use of antipsychotics during pregnancy. The rates of weight gain and gestational diabetes warrant closer attention in the clinical setting.

Largest study to date shows overall use of antipsychotics in pregnancy does not appear to significantly increase the risk of congenital malformations

ABSTRACT FROM: Huybrechts KF, Hernandez-Diaz S, Patorno E, et al . Antipsychotic use in pregnancy and the risk for congenital malformations. JAMA Psychiatry 2016;73:938–46. Atypical and typical antipsychotics (APs) are...

Safety and Efficacy of Antipsychotics in Pregnancy and Lactation

The clinical profiles of antipsychotic medications have improved dramatically since the first generation was introduced in the 1950s. Second Generation Antipsychotic medications (SGAs), which became available in 1990, generate fewer side effects, including reduced incidence of extrapyramidal symptoms such as hyperprolactinemia. This improves the female patients’ ability to become pregnant, a process which is compromised by first generation drugs. However, use of antipsychotic medications has become increasingly prevalent. The likelihood of females with depression, bipolar disorder, psychosis to have an unplanned pregnancy, and the incidence of foetal exposure to psychotropic drugs during the first trimester of pregnancy has also increased. The paucity of exposure and outcome data leaves the safety and effects of use of antipsychotic medications during pregnancy as a subject to controversy. The evidence is insufficient to provide adequate support for clinical practices, and also to the professionals in the related fields of psychiatry, obstetrics-gynecology, and primary care. There is often contradicting information given to patients due to the lack of current studies pertaining to this area. The studies of SGA’s use during breastfeeding suggest that olanzapine, risperidone, and quetiapine may be safe at certain levels whereas medications like clozapine achieve relatively high concentrations in breast milk and may cause agranulocytosis and somnolence. Therefore, the purpose of this review is to report the most relevant and up-to-date findings of antipsychotic medication use during pregnancy and lactation in detail, so that physicians may have more insight regarding medications and provide female patients of childbearing potential with knowledge of the benefits and risks of antipsychotic drugs.

No Increase in Congenital Malformations with Use of Antipsychotics in Pregnancy.

No Increase in Congenital Malformations with Use of Antipsychotics in Pregnancy.

Managing Your Own Mood Lability: Use of Mood Stabilizers and Antipsychotics in Pregnancy.

The management of psychiatric disorders during the perinatal period can be difficult; psychiatric decompensation during pregnancy can affect not only the mother but also the fetus and neonate. It is imperative that psychiatric providers proactively discuss pregnancy planning, and be able to thoughtfully weigh the risks of untreated psychiatric illness and psychotropic medications in pregnancy and breast-feeding. With the exception of valproate and carbamazepine, several mood stabilizers and antipsychotics can be utilized during pregnancy with minimal risk to the fetus and neonate in terms of major malformations; there is a growing body of evidence regarding the risk profile of use of these medications in pregnancy. Key Points Preconception planning is very helpful when it can be done; consider discussion and documentation of risks at time of administration of psychotropic medications for any reproductive-aged women, regardless of plans for conception. Continued psychiatric stability through the perinatal period is imperative; the risks of an untreated psychiatric disorder are just as important, if not more so important, than the risks of psychotropic medication exposure. Exposure to one psychotropic medication is safer than exposure to multiple medications. Utilize lowest effective dose of medication; most risks are not dose dependent, therefore would typically prefer higher dose of medication, rather than emergence of psychiatric symptoms, in order to avoid exposure of the fetus to both psychotropic medications and psychiatric symptoms. General recommendations are to avoid valproate and carbamazepine in reproductive-aged women. With close monitoring, lithium can be safely utilized in pregnancy. Preliminary data regarding use of atypical antipsychotics is reassuring in regards to major malformations; however, larger numbers of participants are needed to provide more complete reproductive safety data with this class. Clearly document risks of an untreated psychiatric illness as well as risks of psychotropic medication management to the mother and developing fetus/neonate.

Atypical Antipsychotics in Pregnancy: New Data on Risks

With substantial numbers of childbearing women now receiving atypical antipsychotic medications (AAs), patients and clinicians are concerned about

Antipsychotics in pregnancy and lactation.

Research on psychotropic medications during pregnancy and lactation is limited as often involves complex ethical issues. Information on safety of psychotropic drugs during these critical phases is either inconclusive or undetermined. Many women with severe mental illness have unplanned pregnancies and require antipsychotic medication during pregnancy and lactation. Multiple issues have to be considered while choosing safe treatments for pregnant and lactating women and the best approach is to individualize the treatment. Medication should be guided primarily by its safety data and by the psychiatric history of the patient. Important issues to be kept in mind include pre-pregnancy counseling for all women, including planning pregnancies; folate supplementation, discussion with patient and family regarding options, and active liaison with obstetricians, ultrasonologists and pediatricians. Whenever possible, non-pharmacological approaches should be used in addition.

Discontinuation of antipsychotic medication in pregnancy: A cohort study

BackgroundWomen prescribed antipsychotics face the dilemma on whether to continue medication in pregnancy in terms of balancing risks and benefits. Previous research on other psychotropic medications suggests that many women discontinue treatment in early pregnancy. However, very limited evidence exists on discontinuation of antipsychotic medication. MethodsWe identified 495,953 pregnant women from THIN primary care database. Kaplan–Meier plots were used to examine time to last antipsychotic prescription. Poisson regression was used to examine characteristics of those who stopped treatment during pregnancy. ResultsThere has been an overall increase in prevalence of antipsychotic prescribing since 2007. However, antipsychotics were more likely to be stopped in pregnant than non-pregnant women. Only 107/279 (38%) of women on atypical antipsychotics and 39/207 (19%) of women on typical antipsychotics before pregnancy still received treatment at the start of third trimester. Older women were more likely to continue typical antipsychotic treatment in pregnancy (35+ versus <25years risk ratio: 3.09 [95% CI 1.76, 5.44]). Likewise, those who received typical antipsychotics for longer periods before were most likely to continue treatment in pregnancy (12+ versus <6months: RR: 3.12 [95% CI 1.97, 4.95]). For atypical antipsychotics length and dose of prior prescribing were also associated with continuation in pregnancy. ConclusionsPregnancy was a major determinant of cessation of antipsychotics. Only 38% of women on atypical and 19% on typical antipsychotics were still prescribed the drug in the third trimester. Duration of prior treatment, maternal age as well as dose was significantly associated with continued treatment of antipsychotics in pregnancy.

The Evidence-based guide to antipsychotic medications

Introduction. Schizophrenia and schizoaffective disorder. Mood and anxiety disorders. Personality disorders. Substance abuse disorders. Use of antipsychotics in children and adolescents. Use of antipsychotics in geriatric patients. Use of antipsychotics in medically ill patients. Appendix 1: names, strengths, and formulations of first- and second-generation antipsychotics. Appendix 2: pharmacokinetics of first- and second-generation antipsychotics. Appendix 3: dosing and administration of of first- and second-generation antipsychotics in schizophrenia. Appendix 4: medical workup when initiating and continuing first- and second-generation antipsychotics. Appendix 5: medical workup when initiating and continuing clozapine. Appendix 6: use of first- and second-generation antipsychotics for agitation due to psychosis. Appendix 7: side effects of commonly used antipsychotics. Appendix 8: management of treatment-emergent side effects of antipsychotic medications. Appendix 9: use of first- and second-generation antipsychotics in pregnancy and lactation. Index.

Management of Antipsychotic and Mood Stabilizer Medication in Pregnancy: Recommendations for Antenatal Care

The aim of the present study was to develop recommendations for antenatal care and monitoring for women with bipolar disorder and schizophrenia who are on lithium carbonate, antipsychotic or anti-epileptic medication during pregnancy. A literature search and review of original research, published reviews and guidelines was undertaken for mood stabilizers and antipsychotics in pregnancy and for the management of bipolar disorder and schizophrenia in pregnancy. This information was summarized, condensed and then reviewed by representatives of psychiatry, pharmacy, paediatrics and obstetrics to produce an information booklet and subsequently monitoring recommendations and tables. A model of antenatal monitoring and care for women with schizophrenia, bipolar disorder and related disorders who are maintained on psychotropic medication was developed. This included an online and published booklet for clinicians summarizing psychotropic medication in pregnancy, and lactation and monitoring tables that could be part of patient case files. These were to assist in reminding and educating staff on the need for additional monitoring and assessment above standard antenatal care for women on mood stabilizers and antipsychotic medication. Women with bipolar disorder and schizophrenia have an increased risk of complications in pregnancy from their illness and from the medications they are prescribed. A summary of the risks and a model of suggested additional monitoring during pregnancy have been developed in consultation across a number of clinical disciplines.

Antipsychotics in pregnancy

Women who are pregnant and who have a history of psychosis are commonly managed with antipsychotic medications. The evidence regarding the use of antipsychotics in pregnancy has been insufficient to provide adequate support for this practice and is a concern for clinicians and women alike. This review presents literature surrounding the use of antipsychotic medications in pregnancy, providing an overview of the historical and contemporary perspectives which influence clinicians prescribing practices. Data were sourced from Medline, CINAHL, PsycINFo, using the terms antipsychotics with pregnancy and psychosis or schizophrenia. This was expanded to include the most common atypical antipsychotics: olanzapine, risperidone, clozapine, quetiapine, ziprasidone and aripiprazole. Literature was found reporting the use of antipsychotic medications in pregnancy since the introduction of antipsychotics in the 1950s, comprising mainly of authors' reviews of the literature, case studies, retrospective reports, drug company registries and more recently a prospective comparative study. This review identifies that the literature provides no clear answer for clinicians as to the risk associated with the use of antipsychotics in pregnancy. To this effect, recently in Australia, the National Register of Antipsychotic Medications in Pregnancy was established to prospectively collect information regarding outcomes for mother and baby, when antipsychotic medications have been used during pregnancy.

Atypical antipsychotic use in pregnancy: a retrospective review

To determine the prevalence of use of atypical antipsychotics in pregnancy and describe infant outcomes associated with these exposures. A retrospective chart review of all pregnant women presenting at our medical center, from the years 1993 to 2007, was conducted. 30,092 total deliveries during that time period were identified. 16 mothers were treated with atypical antipsychotics during their pregnancy. The medical charts of the infants exposed to atypical antipsychotics during pregnancy were reviewed to determine their outcomes, including gestational age, birth weight, and malformations. Only 16 (0.053%) of the women took an atypical antipsychotic at some point during the antenatal period. Average gestational age was 37 5/7 weeks with a standard deviation of 2.54 days. Average birth weight was 3,188 g with a standard deviation of 615 g, which is appropriate for early gestational age. One (6.25%) major malformation was noted. Additional studies need to be completed regarding the effect of atypical antipsychotic use in pregnancy and outcomes related to gestational age, birth weight and malformations.

Olanzapine plasma concentration in a newborn

Little is known about the use of antipsychotics in pregnancy and the corresponding plasma levels in the newborn child. We report on a woman with schizophrenia treated with olanzapine during pregnancy. Plasma levels of olanzapine were assessed both from the mother and from umbilical cord. The plasma level of the newborn (11 ng/mL) was about one third compared to the mother (range 25-34 ng/mL).The development of the fetus, delivery and the development of the child during the first six months were normal.