Neonatal hypoglycaemia following maternal olanzapine therapy during pregnancy: a case report

Rowe, Melissa; Gowda, Bharath A.; Taylor, David; Hannam, Simon; Howard, Louise M.

doi:10.1177/2045125312460395

Cited by 11 publications

(4 citation statements)

References 15 publications

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“…Another study of 18 pregnancies provided similar results, suggesting that olanzapine was relatively safe when used during pregnancy [ 14 ]. There was also one case report suggesting that the use of olanzapine during pregnancy was associated with neonatal hypoglycemia due to hyperinsulinemia [ 15 ] unconfirmed in our cases where the glucose level was normal, while insulin levels had not been taken (not mandatory in the local protocol).…”

Section: Discussionsupporting

confidence: 53%

Dilemma of treating schizophrenia during pregnancy: a Case series and a review of literature

et al. 2017

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BackgroundThe choice of antipsychotic treatment during pregnancy remains controversial, mainly due to a lack of exposure and outcome data. Randomized clinical trials are practically impossible due to ethical reasons. Our reports describe three cases of closely monitored female patients with schizophrenia who were treated with olanzapine during pregnancy. The novelty of reports is that all patients were previously treated with olanzapine long acting injectable (LAI) for an average period of 3.8 years. During the LAI treatment period they were in remission and then refused to continue with LAI mainly due to treatment modality (injectable administration).Case presentationThe patients were relatively young, diagnosed with schizophrenia and were previously successfully treated with long acting injectable. The women were pregnant for the first time. In two cases, the patients had become pregnant during remission and they continued treatment with oral olanzapine. In the third case, olanzapine treatment was initiated during admission for a relapse.ConclusionsThere are no controlled studies for the use of olanzapine therapy in pregnant women. More studies are needed to determine the effects of antipsychotics, including olanzapine, on pregnant women and the developing fetus. Schizophrenia relapse during pregnancy may expose the mother and the fetus to high risk if olanzapine is stopped. It is important to assess the risks and benefits of treating pregnant or breastfeeding women with antipsychotics, and weigh these against possible risks of anomalies and developmental problems to the fetus or child.

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Section: Discussionsupporting

confidence: 53%

Dilemma of treating schizophrenia during pregnancy: a Case series and a review of literature

et al. 2017

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“…No signs of neurodevelopmental delay were detected in the baby. Other cases with healthy developmental outcomes were described in a baby born to a woman diagnosed with bipolar I disorder, despite the fact that the neonate had suffered from severe hypoglycemia after birth; 18 in a baby antenatally exposed to olanzapine and “classic” mood stabilizing agents 19 ; and in a baby born to a mother with schizoaffective disorder exposed in utero to olanzapine monotherapy 20 . In a case-series study of 10 babies born to women with a history of serious mental illness and who were exposed to antipsychotics, 21 data on neurobehavioral outcomes were available for 4 infants, 3 of them exposed to olanzapine.…”

Section: Resultsmentioning

confidence: 99%

Neurodevelopmental outcomes in infants exposed in utero to antipsychotics: a systematic review of published data

Gentile

Fusco²

2016

CNS Spectr.

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The proportion of pregnancies exposed to either second-generation antipsychotics (SGAs) or first-generation antipsychotics (FGAs) varies between 0.3%-2% of all pregnancies, but, until now, little is known about the potential neurobehavioral teratogenicity of antipsychotics. Assessing this safety facet is the aim of this article. PubMed, Scopus, and Google Scholar were searched for eligible articles. PubMed (1954 to May 2016) was searched using several medical subject headings, variously combined. PubMed search results were also limited using the search filter for human studies published in English. Scopus and Google Scholar searches were filtered for article title (antipsychotics/neuroleptics, pregnancy). After excluding duplicates, 9,250 articles were identified and 29 met the following inclusion criteria: only articles that provided original/primary data on neurodevelopmental outcome in human offspring older than 4 months of age, independently of the study design, were selected for review. Indeed, some relevant neurodevelopmental milestones are achieved at this time. Length of study and neurodevelopmental assessment methodology did not influence the study selection. Unfortunately, published data on neurodevelopmental teratogenicity of SGAs mainly derive from case reports and small case-series studies. Even findings emerging from case-control and prospective/retrospective studies are of limited clinical relevance because of their small sample sizes. Limited data are also available on FGAs. Hence, we have to conclude that the long-term neurodevelopmental outcomes for children exposed in utero remain unclear. Low to very low quality evidence of retrieved data makes impossible to confirm or exclude potential long-lasting untoward effects on infant neurocognitive development associate with antenatal exposure to either SGAs or FGAs.

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“… 10 Another study of 18 pregnancies yielded similar results, suggesting that olanzapine is relatively safe when used during pregnancy. 11 There is also one case report suggesting that the use of olanzapine during pregnancy is associated with neonatal hypoglycemia due to hyperinsulinemia, 12 but in this case report glycemic levels were normal, while insulin levels had not been taken.…”

Section: Discussionmentioning

confidence: 70%

Schizophrenia relapse after stopping olanzapine treatment during pregnancy: a case report

Ifteni

Moga

Burtea

et al. 2014

TCRM

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Women with schizophrenia have a high risk for symptom exacerbation or relapse during pregnancy and thereafter. Relapses are more frequent when antipsychotics are discontinued. This paper describes the case of a 28-year old woman with schizophrenia who continued treatment with olanzapine during the first trimester. Olanzapine, a second-generation antipsychotic, was administered at a therapeutic dose from week 1 of gestation until week 13 when she reported the pregnancy to her psychiatrist. Despite the psychiatrist’s recommendation to continue treatment, the patient stopped olanzapine at 20 weeks. She was hospitalized at week 36 for a schizophrenia relapse and was transferred to the obstetrics department where she gave birth by Cesarean section to a normal child. This case is important, illustrating the perils of unplanned pregnancy during antipsychotic treatment and abrupt discontinuation. Ultimately, clinical decisions should be made on a case-by-case basis, weighing the risks to the mother in terms of symptom exacerbation and relapse if antipsychotic treatment is discontinued, and the potential risk to the fetus regarding possible teratogenic effects of continued antipsychotic treatment.

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Neonatal hypoglycaemia following maternal olanzapine therapy during pregnancy: a case report

Cited by 11 publications

References 15 publications

Dilemma of treating schizophrenia during pregnancy: a Case series and a review of literature

Dilemma of treating schizophrenia during pregnancy: a Case series and a review of literature

Neurodevelopmental outcomes in infants exposed in utero to antipsychotics: a systematic review of published data

Schizophrenia relapse after stopping olanzapine treatment during pregnancy: a case report

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