Antipsychotic drugs for non-affective psychosis during pregnancy and postpartum

Webb, Roger T.; Howard, Louise; Abel, Kathryn M.

doi:10.1002/14651858.cd004411

Cited by 22 publications

(29 citation statements)

References 14 publications

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“…One of the reasons for this is the previous lack of high-quality evidence. Conducting randomized controlled trials in pregnant women is not acceptable due to ethical issues [38,39]. As a result, the best available data in this area come from prospective observational studies [40].…”

Section: The Effects Of Antipsychotic Medications On Fetal Morphologymentioning

confidence: 99%

Antipsychotic use in pregnancy

Kulkarni¹,

Storch

Baraniuk

et al. 2015

Expert Opinion on Pharmacotherapy

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Given the potential harm of not treating severe psychiatric illnesses during pregnancy, careful administration of antipsychotics is recommended for pregnant women who suffer from severe mental disorders. The most frequently used antipsychotics in pregnancy are olanzapine, risperidone and quetiapine, and do not appear to cause consistent, congenital harm to the fetus. No specific patterns of fetal limb or organ malformation related to these drugs have been reported. There is some evidence suggesting an association between antipsychotic use in pregnancy and the development of gestational diabetes. Also there appears to be an association between antipsychotic medication use in pregnancy and increased neonatal respiratory distress and withdrawal symptoms. Further studies are needed for clinicians to balance good maternal mental health, healthy pregnancies and good infant health outcomes.

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Section: The Effects Of Antipsychotic Medications On Fetal Morphologymentioning

confidence: 99%

Antipsychotic use in pregnancy

Kulkarni¹,

Storch

Baraniuk

et al. 2015

Expert Opinion on Pharmacotherapy

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“…62 Antipsychotics A systematic review published in 2004 on the use of antipsychotics for primary (non-affective) psychosis in pregnancy found no trials meeting the inclusion criteria and concluded that "continued use of antipsychotic drugs in these women in pregnancy and lactation without sound evidence raises serious clinical and ethical concerns." 89 However, in the past decade, as more evidence has accumulated, it seems that antipsychotics are epine use in pregnancy. 110 111 On the basis of population based health data, infants exposed to an SSRI in combination with a benzodiazepine may have a higher incidence of congenital heart defects even when controlling for maternal illness characteristics (adjusted odds ratio 1.18, 0.18 to 2.18).…”

Section: Lithiummentioning

confidence: 99%

Management of psychotropic drugs during pregnancy

Chisolm

Payne

2016

BMJ

104

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Psychiatric conditions (including substance misuse disorders) are serious, potentially life threatening illnesses that can be successfully treated by psychotropic drugs, even during pregnancy. Because few rigorously designed prospective studies have examined the safety of these drugs during pregnancy, the default clinical recommendation has been to discontinue them, especially during the first trimester. However, in the past decade, as more evidence has accumulated, it seems that most psychotropic drugs are relatively safe to use in pregnancy and that not using them when indicated for serious psychiatric illness poses a greater risk to both mother and child, including tragic outcomes like suicide and infanticide. This review presents an up to date and careful examination of the most rigorous scientific studies on the effects of psychotropic drugs in pregnancy. The lack of evidence in several areas means that definite conclusions cannot be made about the risks and benefits of all psychotropic drug use in pregnancy.

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“…Perinatal complications such as preeclampsia and gestational diabetes are more frequent in women with schizophrenia and pose risk for negative birth outcomes [16,21,40,56]. Psychiatric stabilization occurs best on the psychiatric unit and can be more easily accomplished if obstetric, psychiatric, and pediatric services are in close proximity and share treatment plans and understanding of how to best provide integrated care [5,2,57].…”

Section: Treatment Recommendations For This Segment Includementioning

confidence: 99%

Indication for Psychiatric Inpatient Hospitalization for Pregnant Psychotic Women

Spielvogel¹,

Lee²

2010

CWHR

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The purpose of this article is to describe the challenges and opportunities for acute psychiatric inpatient staff to engage the psychotic pregnant woman in optimal psychiatric and obstetric care, in order to facilitate a positive outcome for mother and baby. We will describe the role of comprehensive, integrated services for mentally ill pregnant women, initiated on a specialized Inpatient Women's Issues Consultation Team and delivered in a culturally competent fashion. Illustrations will be taken from a composite case representing several common key clinical situations in our population.The myth that a medication-free pregnancy is always safest for the pregnant woman is dispelled, and thoughtful, individualized, and informed risk-benefit analysis is recommended instead. Risks for psychotic relapse are identified, appreciating that multiple stressors combine to create the need for comprehensive assessment and treatment in inpatient psychiatric units. Close collaboration among psychiatric, obstetric and pediatric inpatient-outpatient services promotes optimal execution of joint treatment planning. Rapidly restoring the woman to competency and engaging her in psychiatric and obstetric decision-making is the goal.In sum, specialized comprehensive services for psychotic pregnant women provide the opportunity for individualized, therapeutic, evidence-based care, addressing the complex mixture of socio-cultural, medical, obstetric and psychiatric issues each woman bears.

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Antipsychotic drugs for non-affective psychosis during pregnancy and postpartum

Cited by 22 publications

References 14 publications

Antipsychotic use in pregnancy

Antipsychotic use in pregnancy

Management of psychotropic drugs during pregnancy

Indication for Psychiatric Inpatient Hospitalization for Pregnant Psychotic Women

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