Pharmacologic treatment of psychiatric disease in pregnancy and lactation: fetal and neonatal effects

Kuller, Jeffrey A.; Katz, Vern L.; McMahon, Michael; Wells, Samuel; Bashford, Robert A.

doi:10.1016/0029-7844(95)00476-9

Cited by 20 publications

(11 citation statements)

References 26 publications

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“…[37,72] Alternatively, in patients with a history of repeated psychotic epi-sodes, maintenance antipsychotics may be indicated to prevent further relapses. It is probably best to avoid antipsychotics during the first trimester if possible.…”

Section: Resultsmentioning

confidence: 99%

Effects of Antipsychotics on the Unborn Child

Pinkofsky

2000

Pediatric Drugs

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The onset of psychosis during pregnancy presents difficult management decisions. A complete and thorough physical and obstetric examination is always warranted to look for possible physiological precipitants. The treatment of pregnant patients with psychotic symptomatology requires close contacts between family members, non-physician professionals involved in the patient's care (e.g. social workers, case managers and home healthcare nurses), and the physicians overseeing the patient's management (e.g. internists, obstetricians and psychiatrists). In mild and less disabling cases it may be possible to avoid medication intervention but this approach risks adverse behaviour consequences resulting from a possible worsening of the patient's symptomatology. Avoiding medication requires an environment in which the patient has strong social supports. Risks are present whether medication is initiated or not, and treatment decisions require a careful assessment of the risks and benefits involved. Initiating medication raises the possibility of obstetric, teratogenic, neurobehavioural and neonatal toxic effects. Research on the risks imposed by antipsychotic drug use during pregnancy is incomplete and raises questions regarding appropriate management. The first trimester represents a period of increased susceptibility to medication-induced teratogenesis. The use of low potency phenothiazines during the first trimester may increase the risk of congenital abnormalities by an additional 4 cases per 1000 (odds ratio = 1.21, p = 0.04) The pharmacological profiles of antipsychotic medications also present adverse effects which need to be considered during pregnancy (hypotension, sedation, etc.). Less is known about the risk of adverse consequences resulting from the use of newer atypical antipsychotic medications. Electroconvulsive therapy is another treatment modality and its use may circumvent the need to introduce antipsychotic medication during pregnancy. It must be stressed that. given current knowledge, no treatment regimen can be considered completely safe. Ultimately many factors must be evaluated when treating psychosis during pregnancy, however, no decision is risk-free.

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Section: Resultsmentioning

confidence: 99%

Effects of Antipsychotics on the Unborn Child

Pinkofsky

2000

Pediatric Drugs

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“…Psychoactive drugs, which often are given for long‐term intervention, are of particular concern, especially during pregnancy, acute illness, and when the patient is undergoing pharmacologic treatment for other medical problems. Awareness of these factors particularly is important during pregnancy as placental membranes do not protect the fetus from psychoactive drugs, and all psychotropic medications cross the placental barrier (50–57).…”

Section: Pharmacokineticsmentioning

confidence: 99%

Psychopharmacologic management of women with common mental health problems

Clarke

Paine²

1997

Journal of Nurse-Midwifery

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“…A specific malformation pattern has been proposed (51, 52), ‘fetal valproate syndrome’, consisting of heart defects and withdrawal syndrome (irritability, jitteriness, hypotonia, and difficulty eating) (53). Vajda & Eadie and Morrow et al found that the rate of major malformations in fetuses exposed to valproate alone or in combination with other epileptic drugs ranges between 15.2% and 17.1%, and between 6.2% and 9.0%, respectively.…”

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confidence: 99%

“…Valproate safety in breastfeeding. VPA concentrations range from less than 1% to 10% in breast milk and infant serum, and from undetectable levels to 40% in maternal serum (33, 53). Thrombocytopenic purpura and anemia were attributed to valproate exposure through placenta and breast milk (55).…”

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confidence: 99%

Prophylactic treatment of bipolar disorder in pregnancy and breastfeeding: focus on emerging mood stabilizers

Gentile

2006

Bipolar Disorders

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Untreated pregnant bipolar women are at an increased risk of poor obstetrical outcomes and relapse of affective symptoms. On the other hand, classic antiepileptic drugs are well-known human teratogens, whereas data on lithium are partially ambiguous. The safety of emerging mood stabilizers in pregnancy and breastfeeding has not been examined extensively. Therefore, when approaching bipolar disorder, if possible, each episode must be considered separately.

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Pharmacologic treatment of psychiatric disease in pregnancy and lactation: fetal and neonatal effects

Abstract: Psychoactive medications may be used during pregnancy. Because data on safety are largely retrospective, treatment decisions must be weighed carefully.

Cited by 20 publications

References 26 publications

Effects of Antipsychotics on the Unborn Child

Effects of Antipsychotics on the Unborn Child

Psychopharmacologic management of women with common mental health problems

Prophylactic treatment of bipolar disorder in pregnancy and breastfeeding: focus on emerging mood stabilizers

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