Maternal mental disorders and pregnancy outcomes: A clinical study in a Japanese population

Hironaka, Masae; Kotani, Tomomi; Sato, Seiji; Tsuda, Hiroyuki; Mano, Yukio; Hayakawa, Hiromi; Tanaka, Satoshi; Ozaki, Norio; Koji, Takehiko; Kikkawa, Fumitaka

doi:10.1111/j.1447-0756.2010.01512.x

Cited by 21 publications

(14 citation statements)

References 24 publications

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“…Our data support an increasing trend in the use of SGAs to treat a variety of psychiatric disorders, with bipolar disorder and depression being reported as the two leading indications and quetiapine being the one most commonly used. We found that 76% (n=101) of women were exposed to SGAs throughout pregnancy and 72% of the assessed cohort received psychotropic drugs in polytherapy, which is in agreement with previous reports 16 19 21 22. Frye et al 23 stated that the proportion of polytherapy treatment increased from 3.3% in 1974–1979 to 44% in 1990–1995 24.…”

Section: Discussionsupporting

confidence: 91%

Pregnancy outcomes following maternal exposure to second-generation antipsychotics given with other psychotropic drugs: a cohort study

et al. 2013

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ObjectivesSecond-generation antipsychotics (SGAs), in conjunction with other psychotropic medications, are increasingly used to treat psychiatric disorders in pregnancy. The few available studies investigating the reproductive safety of SGAs did not reach conclusive results, and none have compared monotherapy with polytherapy involving other psychotropic medications.DesignDescriptive cohort study using a prospectively collected database.SettingMotherisk Program, The Hospital for Sick Children, Toronto, Canada.Participants133 women exposed to SGAs and other psychotropic drugs and 133 matched healthy controls were assessed and analysed. Outcomes of mother–child pairs exposed to SGAs in monotherapy (N=37) were compared with those exposed to SGAs with other psychotropic medications (in polytherapy; N=96).Main outcome measuresMaternal, pregnancy, delivery and neonatal outcomes.Results72% of exposed women received SGAs in polytherapy, and 101 women took their medications throughout pregnancy. These women had significantly higher pre-pregnancy weight, experienced more associated comorbidities and instrumental deliveries, and delivered a greater proportion of large for gestational age neonates. There were no differences in maternal weight gain in pregnancy between the exposed and comparison groups and between the monotherapy-exposed and polytherapy-exposed subgroups. The exposed neonates were more likely to be born premature, were admitted more often to the neonatal intensive care unit, presented with poor neonatal adaptation signs and had higher rates of congenital malformations. All the aforementioned neonatal outcomes were found mainly in the polytherapy subgroup.ConclusionsThe use of SGAs in polytherapy was prevalent in the assessed cohort and was associated with adverse pregnancy outcomes for both the mother and the child. In utero exposure to SGA monotherapy appears to be associated with less risk to the fetus. Future research should focus on polytherapy in pregnancy in order to define its reproductive safety and to separate the effects of medication exposure, underlying psychopathology and associated comorbidities.

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Section: Discussionsupporting

confidence: 91%

Pregnancy outcomes following maternal exposure to second-generation antipsychotics given with other psychotropic drugs: a cohort study

et al. 2013

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“…35,40,45 Moreover, weight gain during pregnancy, an important factor regarding pregnancy outcome, was only documented by 2 studies. 10,24 In addition, pregnant women taking SGAs are more likely to smoke, drink alcohol, use illicit drugs, have unwanted pregnancies, and be in a lower socioeconomic class and are less likely to take prenatal vitamins, 8,10,11,16,17 all of which are factors that may cause adverse pregnancy outcomes and lead to an overestimate of risk in our analysis. Studies using more sound methodologies are needed to consider the effects of disorder, drug dosage, timing and duration during gestation, polytherapies, and other comorbidities on pregnancy outcome.…”

Section: Discussionmentioning

confidence: 96%

“…Although the 12 included studies in this metaanalysis were of high quality, there are still limitations within the individual studies, which weaken the strength of this metaanalysis and which must be considered. First, only 2 studies attempted to adjust for the potential effects of the underlying disease, 17,24 which include schizophrenia, bipolar disorder, and depression, all of which may be associated with adverse pregnancy outcomes and neonatal complications. 32,33,[41][42][43] As discussed, this is a major methodological weakness and affects most of the research in this field.…”

Section: Discussionmentioning

confidence: 99%

“…Another concern is the growing use of polytherapy over monotherapy. Of the 12 studies, 7 reported concomitant drug use among their subjects, 8,10,11,[16][17][18]24 which complicates the risk analysis of individual drugs. The types of concomitant drugs included FGAs, antidepressants, anticonvulsants, benzodiazepines, lithium, anxiolytics, and opioids.…”

Section: Discussionmentioning

confidence: 99%

“…For all other studies, exposure was self-reported by the subject. Of the 12 studies, 7 reported concomitant drug use among their subjects, 8,10,11,[16][17][18]24 which was not controlled for. Eight of the studies included in this analysis reported data obtained from a teratology information service (Motherisk, Teratogen Information Service, Drug Safety Unit Research database, Teratology Information Service, French Regional Pharmacovigilence Centre).…”

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

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Pregnancy Outcomes Following In Utero Exposure to Second-Generation Antipsychotics

Terrana

Koren

Pivovarov³

et al. 2015

Journal of Clinical Psychopharmacology

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Second-generation antipsychotics (SGAs) are increasingly used for a variety of mental illnesses; however, the data regarding the safety of these medications during pregnancy are inconclusive and contradictory. We examined the risk of adverse pregnancy outcomes associated with in utero exposure to SGAs by conducting a systematic review and meta-analysis. We searched the databases EMBASE and MEDLINE from January 1990 to December 2014. Eligible studies had to report pregnant women who took SGAs during pregnancy (first trimester exposure if analyzing congenital malformations), follow a healthy comparison group in a similar manner, and report data on pregnancy outcomes. There was no restriction on language, sample size, or publication date. The primary outcome analyzed was major congenital malformations, and secondary outcomes included miscarriages, stillbirths, preterm births, small or large for gestational age neonates, and differences in gestational ages and birth weights. A total of 12 studies met our inclusion criteria, totalling 1782 cases and 1,322,749 controls. The use of SGA during the first trimester of pregnancy was associated with a significant increased risk for major congenital malformations (odds ratio, 2.03; 95% confidence interval, 1.41-2.93); however, no specific pattern of malformations was found. An increased risk was also found for preterm births (odds ratio, 1.85; 95% CI, 1.20-2.86). The use of SGA during pregnancy was not found to be associated with an increased risk for secondary outcomes analyzed. The absence of a specific pattern of malformations makes it difficult to identify an explicit risk posed by SGAs, and therefore, further studies sufficiently controlling for confounding factors are needed to validate these findings.

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Neonatal outcomes after in utero exposure to antipsychotics: a systematic review and meta-analysis

Joseph-Delaffon,

Eletri,

Dechartres

et al. 2024

Eur J Epidemiol

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Maternal mental disorders and pregnancy outcomes: A clinical study in a Japanese population

Abstract: A trend towards a lower birth weight and shorter gestational age was observed in Japanese women with well-controlled mental disorders, but the effect of well-controlled mental disorders on the perinatal outcome was minimal.

Cited by 21 publications

References 24 publications

Pregnancy outcomes following maternal exposure to second-generation antipsychotics given with other psychotropic drugs: a cohort study

Pregnancy outcomes following maternal exposure to second-generation antipsychotics given with other psychotropic drugs: a cohort study

Pregnancy Outcomes Following In Utero Exposure to Second-Generation Antipsychotics

Neonatal outcomes after in utero exposure to antipsychotics: a systematic review and meta-analysis

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