Side Effects on Fetus and Infant of Psychotropic Drug Use
during Pregnancy

Ananth, Jambur

doi:10.1159/000468239

Cited by 35 publications

(13 citation statements)

References 50 publications

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“…The most often described syndrome after intrauterine exposure to lithium is the floppy infant syndrome, which develops directly after birth. This syndrome consists of symptoms such as hypotonia, hypothermia, respiratory depression, cyanosis, arrhythmias and decrease sucking reflex 19,57,58,60–62,83–86. Although exact figures on incidence are lacking, the incidence is suggested to be low 83.…”

Section: Symptomsmentioning

confidence: 99%

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The use of psychotropic medication during pregnancy: how about the newborn?

Kieviet¹,

Dolman²,

Honig³

2013

NDT

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Infants are at risk of developing symptoms of Poor Neonatal Adaptation (PNA) after exposure to psychotropic drugs in utero. Such symptoms are largely similar after exposure to antidepressants, antipsychotics and benzodiazepines and consist of mostly mild neurologic, autonomic, respirator and gastro-intestinal abnormalities. Most symptoms develop within 48 hours after birth and last for 2–6 days. After exposure to Selective Serotonin Reuptake Inhibitors (SSRIs), mirtazapine or venlafaxine in utero, breastfeeding is presumably protective for development of PNA. The dosage of antidepressants does not seem to be related to the risk of PNA. In order to objectify possible symptoms of PNA, observation of mother and child at the maternity ward is advisable. If PNA symptoms do not occur, an observation period of 48–72 hours is sufficient. This applies to all types of psychotropic drugs. When PNA symptoms are present it is advisable to observe the infant until the symptoms are fully resolved. Observation can be performed by trained nurses using the Finnegan scoring list. This observation list should be administered every 8 hours. Interpretation of the scores should be carried out by a paediatrician. In most cases symptoms are non-specific. Therefore other diagnoses, such as infection or neurologic problems, have to be excluded. When there is any doubt on possible intoxications during pregnancy, toxicological urine screening is indicated. Most cases of PNA are mild, of short duration and self-limiting without need for treatment. Supporting measures such as frequent small feedings, swaddling and increase of skin to skin contact with the mother is usually sufficient. In case of severe PNA it is advised to admit the infant to the Neonatal Care Unit (NCU). Phenobarbital is a safe therapeutic option. There seem to be no major long term effects; however, additional studies are necessary in order to draw definite conclusions.

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Section: Symptomsmentioning

confidence: 99%

“…Other described lithium related symptoms are neonatal thyroid toxicity, nephrogenic diabetes insipidus, cardiovascular and renal dysfunctions, hyperbilirubinemia, hepatotoxicity and PPHN. These symptoms are generally self-limiting 57,59,60,62,83,86. Most symptoms develop within one day and disappear in 2–10 days after birth 62,87.…”

Section: Symptomsmentioning

confidence: 99%

The use of psychotropic medication during pregnancy: how about the newborn?

Kieviet¹,

Dolman²,

Honig³

2013

NDT

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“…These include several cases of muscular hypotonia with impaired breathing and cyanosis, often referred to as "floppy baby" syndrome (62,65,(70)(71)(72). Isolated cases of neonatal hypothyroidism, nephrogenic diabetes insipidus, and polyhydramnios have also been described (70,72).…”

Section: Fetal Risks Associated With Drugs Used Tomentioning

confidence: 99%

Managing Bipolar Disorder during Pregnancy: Weighing the Risks and Benefits

et al. 2002

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Background: Challenges for the clinical management of bipolar disorder (BD) during pregnancy are multiple and complex and include competing risks to mother and offspring. Method: We reviewed recent research findings on the course of BD during pregnancy and postpartum, as well as reproductive safety data on the major mood stabilizers. Results: Pregnancy, and especially the postpartum period, are associated with a high risk for recurrence of BD. This risk appears to be limited by mood-stabilizing treatments and markedly increased by the abrupt discontinuation of such treatments. However, drugs used to treat or protect against recurrences of BD vary markedly in teratogenic potential: there are low risks with typical neuroleptics, moderate risks with lithium, higher risks with older anticonvulsants such as valproic acid and carbamazepine, and virtually unknown risks with other newer-generation anticonvulsants and atypical antipsychotics (ATPs). Conclusions: Clinical management of BD through pregnancy and postpartum calls for balanced assessments of maternal and fetal risks and benefits. Contexte: Les problèmes liés au traitement clinique du trouble bipolaire (TB) durant la grossesse sont profonds et peuvent entraîner des risques concurrents pour la mère et l'enfant. Méthode: Nous avons examiné les résultats récents de la recherche sur le cours du TB durant la grossesse et le post-partum, de même que les données d'innocuité reproductrice des principaux régulateurs de l'humeur. Résultats: La grossesse et surtout la période du post-partum comportent des risques élevés de récurrence du TB. Les risques semblent être limités par les traitements aux régulateurs de l'humeur et notablement accrus par la cessation abrupte de ces traitements. Toutefois, les médicaments utilisés pour traiter ou prévenir les récurrences du TB varient beaucoup en ce qui concerne les risques tératogènes: les risques sont faibles pour les neuroleptiques typiques, modérés pour le lithium, élevés pour les anciens anticonvulsivants comme l'acide valproïque et la carbamazépine, et presque inconnus pour les autres anticonvulsivants de la nouvelle génération et les antipsychotiques atypiques (APA). Conclusions: Le traitement clinique des femmes souffrant du TB durant la grossesse et le post-partum demande des évaluations équilibrées des risques et des avantages pour la mère et le foetus.

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“…Though there has been little consistent evidence that antipsychotics act as gross te ratogens [3,69,70], some studies have shown an increase in the congenital malfor mation rate in infants of mothers exposed to antipsychotics during pregnancy and there have been sporadic case reports of afflicted infants [2,71], In addition, concern has been raised that although phenothiazines may not produce gross malformations, they may have a 'behavioral teratogenic' effect [2,3], In order to develop most gross malformations, the embryo must be exposed to a teratogen during the first trimester when the organs are forming. Unlike other systems, the CNS con tinues developing into adolescence, so that exposure of the immature CNS to antipsychotics at any time during pregnancy or childhood may, theoretically, result in subtle behavioral changes [2,3], The maternal use of antipsychotics throughout pregnancy and nursing may thus present a risk to the off spring.…”

Section: Obstetrical Patientsmentioning

confidence: 99%

“…The use of the older antipsychotics with which there has been the greatest clinical experience is suggested [2,3], When antipsychotics are used just prior to delivery, the neonate may display the side effects of these agents. These include extra pyramidal symptoms, as well as the small left colon syndrome [2,3,69,72], There has also been evidence that the newborn may suffer from respiratory suppression [2,69]. Antipsychotics are excreted in breast milk and, although no adverse reactions in nursing in fants have been reported [4,5], caution should be exercised.…”

Section: Obstetrical Patientsmentioning

confidence: 99%

Antipsychotic Use in the Medically Ill

Silver¹,

Simpson²

1988

Psychother Psychosom

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Antipsychotics are of use in a variety of medical settings. They can be used to treat organic mental disorders resulting from the medical illness and its therapy, as well as to control the symptoms of coexisting psychiatric conditions. Antipsychotics also have a variety of nonpsychiatric applications. This paper will review these uses of antipsychotic agents and how their administration must be modified in the medically ill.

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Side Effects on Fetus and Infant of Psychotropic Drug Use during Pregnancy

Cited by 35 publications

References 50 publications

The use of psychotropic medication during pregnancy: how about the newborn?

The use of psychotropic medication during pregnancy: how about the newborn?

Managing Bipolar Disorder during Pregnancy: Weighing the Risks and Benefits

Antipsychotic Use in the Medically Ill

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