Antipsychotic Therapy During Early and Late Pregnancy A Systematic Review.docx
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Antipsychotic Therapy During Early and Late Pregnancy A Systematic Review.docx
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AntipsychoticTherapyDuringEarlyandLatePregnancyASystematicReview
http:
//www.ncbi.nlm.nih.gov/pmc/articles/PMC2879689/
SchizophrBull.2010May;36(3):
518–544.
Publishedonline2008September11.doi:
10.1093/schbul/sbn107
PMCID:
PMC2879689
AntipsychoticTherapyDuringEarlyandLatePregnancy.ASystematicReview
SalvatoreGentile1,2
2DepartmentofMentalHealthASLSalerno1,MentalHealthCentern.4,PiazzaGaldi,841013Cavade’Tirreni(Salerno),Italy
1Towhomcorrespondenceshouldbeaddressed;tel:
+39-089-4455439,fax:
+39-089-4455440,e-mail:
salvatore_gentile@alice.it.
Authorinformation►CopyrightandLicenseinformation►
Copyright©TheAuthor2008.PublishedbyOxfordUniversityPressonbehalfoftheMarylandPsychiatricResearchCenter.Allrightsreserved.Forpermissions,pleaseemail:
journals.permissions@oxfordjournals.org.
ThisarticlehasbeencitedbyotherarticlesinPMC.
Goto:
Abstract
Objective:
Bothfirst-(FGAs)andsecond-generationantipsychotics(SGAs)areroutinelyusedintreatingsevereandpersistentpsychiatricdisorders.However,untilnownoarticleshaveanalyzedsystematicallythesafetyofbothclassesofpsychotropicsduringpregnancy.Datasourcesandsearchstrategy:
Medicalliteratureinformationpublishedinanylanguagesince1950wasidentifiedusingMEDLINE/PubMed,TOXNET,EMBASE,andTheCochraneLibrary.Additionalreferenceswereidentifiedfromthereferencelistsofpublishedarticles.Bibliographicalinformation,includingcontributoryunpublisheddata,wasalsorequestedfromcompaniesdevelopingdrugs.Searchtermswerepregnancy,psychotropicdrugs,(a)typical-first-second-generationantipsychotics,andneuroleptics.Aseparatesearchwasalsoconductedtocompletethesafetyprofileofeachreviewedmedication.SearcheswerelastupdatedonJuly2008.Dataselection:
Allarticlesreportingprimarydataontheoutcomeofpregnanciesexposedtoantipsychoticswereacquired,withoutmethodologicallimitations.Conclusions:
ReviewedinformationwastoolimitedtodrawdefiniteconclusionsonstructuralteratogenicityofFGAsandSGAs.Bothclassesofdrugsseemtobeassociatedwithanincreasedriskofneonatalcomplications.However,mostSGAsappeartoincreaseriskofgestationalmetaboliccomplicationsandbabieslargeforgestationalageandwithmeanbirthweightsignificantlyheavierascomparedwiththoseexposedtoFGAs.TheseriskshavebeenreportedrarelywithFGAs.Hence,thechoiceofthelessharmfuloptioninpregnancyshouldbelimitedtoFGAsindrug-naivepatients.Whenpregnancyoccursduringantipsychotictreatment,thechoicetocontinuetheprevioustherapyshouldbepreferred.
Keywords:
antipsychotics,gestationalmetaboliccomplications,neuroleptics,neonatalcomplications,pregnancy,safety
Goto:
Introduction
Thefertilityrateamongwomensufferingfromschizophrenicandothersevereandpersistentpsychiatricdisorders(SPPDs)hasincreasedsincedeinstitutionalization.
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Destroyuserinterfacecontrol2Thismaybeasadirectresultofavailabilityofsexualpartnersorconcurrentchangingattitudestowardconceptionamongthosewithseriousmentalillness.
Thefollowingpopperuserinterfacecontrolmaynotbeaccessible.Tabtothenextbuttontorevertthecontroltoanaccessibleversion.
Destroyuserinterfacecontrol3Thegrowingdiffusionofsecond-generationantipsychotics(SGAs),exceptforrisperidone,lesslikelythanfirst-generationantipsychotics(FGAs)toinducehyperprolactinemia,mayhavealsocontributedtoimprovedfecundityinthispopulationofpatients.
Unfortunately,however,unplannedandunwantedpregnanciesoccurmorefrequentlyinwomenwithSPPDsthaninthegeneralpopulation.
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Destroyuserinterfacecontrol5Thismayresultindelayedorpoorantenatalcareandunhealthybehavior(suchasalcoholandstreetdrugconsumption)thatmaybeavoidedifthewomanismadeawareofherstatus.
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Evidenceregardingtheimpactofpregnancyonthecourseofschizophreniaisinconclusive:
however,McNeiletal
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Destroyuserinterfacecontrol7foundthatinthosewomenwithahistoryofapsychoticdisorder,duringpregnancyaworseningratherthananimprovementofsymptomswasmorecommon.
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Destroyuserinterfacecontrol8Regardingbipolardisorder,therearesomepeculiarfeaturesofbipolarwomenthatsetthemapartfromotherpatientpopulations.Womenwithbipolardisorderaretypicallyintheirteensandearly20satonsetoftheillness,placingthematriskofmoodepisodesduringchildbearingage.
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Destroyuserinterfacecontrol9Thefemalereproductivecyclealsointroducesmultifactorialcomplexitiesintothetreatmentofthedisease.
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Destroyuserinterfacecontrol10Thecourseofrecurrenceisoftensevereandcharacterizedbyarelativelyhighfrequencyofrapid-cyclingforms,mixedmania,andantidepressant-inducedmania.
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Destroyuserinterfacecontrol11,
Thefollowingpopperuserinterfacecontrolmaynotbeaccessible.Tabtothenextbuttontorevertthecontroltoanaccessibleversion.
Destroyuserinterfacecontrol12Theissueofwhetherbipolardisorderimprovesduringpregnancyiscontroversial
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Destroyuserinterfacecontrol13–
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Destroyuserinterfacecontrol16;however,pregnancyseemsnottobeprotectiveforallbipolarwomen.Indeed,duringthegestationalperiod,riskofarelapseofthedisorderdoesnotdecrease.
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Consequently,itisparticularlyimportantthatthementalhealthofwomenwithSPPDsisstableiftheyareabouttobecomeparents.
BothFGAsandSGAsareknownasindispensableeffectivemedicationsforSPPDs.
Thefollowingpopperuserinterfacecontrolmaynotbeaccessible.Tabtothenextbuttontorevertthecontroltoanaccessibleversion.
Destroyuserinterfacecontrol18Untilnow,however,onlyonerelativelyrecentsystematicreviewhasinvestigatedthesafetyofSGAsinpregnancy.
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Destroyuserinterfacecontrol19Nonetheless,dataonthereproductivesafetyofbothSGAshavegraduallyaccumulatedaddingfurtherinformationontheuseofsuchagentstothesevulnerablemothers.
ThelackofupdatedarticlesonFGAsmayreflectreducedscientificinterestinclinicalsafetyofthisclassofmedications.However,theyshouldnotbeconsideredasaforgottentherapy.
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Destroyuserinterfacecontrol20Moreover,almostallpreviousreviewsonthistopicshowanarrativedesign.
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Destroyuserinterfacecontrol21–
Thefollowingpopperuserinterfacecontrolmaynotbeaccessible.Tabtothenextbuttontorevertthecontroltoanaccessibleversion.
Destroyuserinterfacecontrol23Regrettably,conclusionsemergingfromnarrativereviewsofscientificliteraturemaybebiasedbyastudyselectionbasedonsubjectivemethodologies,andsomeoftheanalyzedstudiesmighthavereflectedtheauthors’personalpointofview,ratherthanreflectingintrinsicscientificvalidity.
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Destroyuserinterfacecontrol24Furthermore,asingle(nonrecent)meta-analysiswasableonlytoprovidestatisticalanalysisofpregnancyoutcomesfollowingfirsttrimesterexposureoflow-potencyneuroleptics.
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Destroyuserinterfacecontrol25
Anupdatedandsystematicreviewofstudiesfocusedoninvestigatingsafetyofbothclas
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