Birth Weight and Use of Olanzapine in Pregnancy

Babu, Girish N.; Desai, Geetha; Tippeswamy, Harish; Chandra, Prabha S.

doi:10.1097/jcp.0b013e3181db8734

Cited by 29 publications

(18 citation statements)

References 9 publications

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“…Journal of Psychopharmacology 25(5) (Babu et al, 2010;McKenna et al, 2005;Newham et al, 2008;Newport et al, 2007;Reis and Ka¨lle´n, 2008). This may be explained by differences in these samples with regards to other factors that determine birth weight, such as maternal body mass index and weight gain during pregnancy, lifestyle and socioeconomic factors.…”

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confidence: 87%

Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology

2011

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These guidelines from the British Association for Psychopharmacology address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting, involving experts in schizophrenia and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from the participants and interested parties, and cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. The practice recommendations presented are based on the available evidence to date, and seek to clarify which interventions are of proven benefit. It is hoped that the recommendations will help to inform clinical decision making for practitioners, and perhaps also serve as a source of information for patients and carers. They are accompanied by a more detailed qualitative review of the available evidence. The strength of supporting evidence for each recommendation is rated.

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confidence: 87%

Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology

2011

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“…Similarly, maternal use of antipsychotics has been reported to result in aberrant fetal growth. Indeed maternal antipsychotic use has been reported to result in an increased incidence of both low and high birth weight relative to the general population [23, 24, 28, 29]. Since being either too small or too large at birth is a risk factor for the development of metabolic syndrome in postnatal life [30–32], children exposed to antipsychotic medications in utero may be at increased risk of developing obesity in postnatal life.…”

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confidence: 99%

Effect of Atypical Antipsychotics on Fetal Growth: Is the Placenta Involved?

Raha

Taylor

Holloway

2012

Journal of Pregnancy

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There is currently considerable uncertainty regarding prescribing practices for pregnant women with severe and persistent psychiatric disorders. The physician and the mother have to balance the risks of untreated psychiatric illness against the potential fetal toxicity associated with pharmacological exposure. This is especially true for women taking atypical antipsychotics. Although these drugs have limited evidence for teratological risk, there are reports of altered fetal growth, both increased and decreased, with maternal atypical antipsychotic use. These effects may be mediated through changes in the maternal metabolism which in turn impacts placental function. However, the presence of receptors targeted by atypical antipsychotics in cell lineages present in the placenta suggests that these drugs can also have direct effects on placental function and development. The signaling pathways involved in linking the effects of atypical antipsychotics to placental dysfunction, ultimately resulting in altered fetal growth, remain elusive. This paper focuses on some possible pathways which may link atypical antipsychotics to placental dysfunction.

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“…Clinical outcome studies following prenatal antipsychotic administration are limited to analyses using small sample sizes of placental passage rates, 12 neonatal outcomes, 13,14 and the risk for delivery complications and congenital malformations. 11,15–19 A previous study reported hypertonicity, tremulousness, and poor motor maturity in neonates within days of delivery following prenatal exposure to first-generation antipsychotics (FGAs).…”

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Prenatal Antipsychotic Exposure and Neuromotor Performance During Infancy

Johnson

LaPrairie

Brennan

et al. 2012

Arch Gen Psychiatry

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Context Despite the expanding clinical utility of antipsychotics beyond psychotic disorders to include depressive, bipolar, and anxiety disorders, reproductive safety data regarding the neurodevelopmental sequelae of fetal antipsychotic exposure are scarce. Objective To examine whether intrauterine antipsychotic exposure is associated with deficits in neuromotor performance and habituation in 6-month-old infants. Design, Setting, and Participants A prospective controlled study was conducted from December 1999 through June 2008 at the Infant Development Laboratory of the Emory Psychological Center examining maternal-infant dyads (N=309) at 6 months postpartum with pregnancy exposure to antipsychotics (n=22), antidepressants (n = 202), or no psychotropic agents (n = 85). Examiners masked to maternal-infant exposure status administered a standardized neuromotor examination (Infant Neurological International Battery [INFANIB]) that tests posture, tone, reflexes, and motor skills and a visual habituation paradigm using a neutral female face. Main Outcome Measures The INFANIB composite score; number of trials required to achieve a 50% decrease in infant fixation during a visual habituation task; and mean time looking at the stimulus across 10 trials. Results Infants prenatally exposed to antipsychotics (mean=64.71) showed significantly lower INFANIB scores than those with antidepressant (mean=68.57) or no psychotropic (mean=71.19) exposure, after controlling for significant covariates (F2,281=4.51; P =.01; partial η2=0.033). The INFANIB scores were also significantly associated with maternal psychiatric history, including depression, psychosis, and overall severity/chronicity (P’s<.05) and maternal depression during pregnancy was associated with less efficient habituation (r245=0.16; P <.02). There were no significant differences regarding habituation between medication exposure groups. Conclusions Among 6-month-old infants, a history of intrauterine antipsychotic exposure, compared with antidepressant or no psychotropic exposure, was associated with significantly lower scores on a standard test of neuromotor performance, highlighting the need for further scrutiny of the reproductive safety and neurodevelopmental sequelae of fetal antipsychotic exposure. Disentangling medication effects from maternal illness effects, which also contributed, remains a critical challenge.

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Birth Weight and Use of Olanzapine in Pregnancy

Cited by 29 publications

References 9 publications

Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology

Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology

Effect of Atypical Antipsychotics on Fetal Growth: Is the Placenta Involved?

Prenatal Antipsychotic Exposure and Neuromotor Performance During Infancy

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