By Dr Abida Sajjad, Psychiatrist
Mental disorder in pregnancy is a significant public health challenge. Data from the 2000- 2002 Confidential Enquiries into Maternal Deaths found that suicide was the leading cause of maternal deaths and, while the data for 2006-2008 shows this is no longer the case, suicide remains one of the major causes of maternal death.
The use of antipsychotics in pregnancy has increased substantially in the past decade, but information as to their safety has been limited(JAMA Psychiatry,2016). Exposure to antipsychotics (APs) during pregnancy is increasingly common. Antipsychotics are a range of medications that are used for some types of mental distress or disorder - such as schizophrenia or bipolar disorders - or used with antidepressants to treat depression.
There are two different groups of antipsychotics. The first type is titled "typical" - an older type of drug that first appeared in the mid-1950s. They block the action of dopamine, some more strongly than others."Atypical" antipsychotics - newer medications - still block dopamine, but on a smaller scale. They also work on different chemical messengers in the brain such as serotonin.
Little is known regarding the safety of APs on the developing fetus, however, and concerns have previously been raised about a potential association between antipsychotics and congenital malformations. The latest study, published in JAMA Psychiatry, examined the risk of congenital and cardiac malformations associated with first-trimester exposure to antipsychotics.
Krista F.G. Huybrechts, M.S., Ph.D., an associate epidemiologist in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital and Harvard Medical School, and co-authors used a nationwide Medicaid database sample of over 1.3 million pregnant women enrolled from 3 months before their last menstrual period through at least 1 month after delivery.
Exposure to antipsychotics was defined as filling at least one prescription during the first trimester of pregnancy and individual drugs including aripiprazole, olanzapine, quetiapine fumarate, risperidone, and ziprasidone were assessed.
According to the results, among the more than 1.3 million women, 9,258 women (0.69 percent) filled a prescription for an atypical AP, and 733 women (0.05 percent) filled a prescription for a typical AP during the first trimester. The most frequently used atypical APs in order of frequency were quetiapine, aripiprazole, risperidone, olanzapine, and ziprasidone.
Evidence from this large study suggests that use of APs early in pregnancy generally does not meaningfully increase the risk for congenital malformations overall or cardiac malformations in particular. The small increase in the risk for malformations observed with risperidone requires additional study.
Katherine L. Wisner, M.D., of the Northwestern University Feinberg School of Medicine in Chicago, IL, and co-authors write about the above report in a related editorial: "This landmark report, with the largest population of women exposed to APs published to date to our knowledge, demonstrates that exposure to APs (other than risperidone) does not significantly increase the risk of birth defects, which has been a major source of concern for women and prescribers,".
According to another study taking atypical antipsychotics in the first trimester of pregnancy does not seem to be associated with an increased likelihood of major malformations or premature birth, although there is some evidence to suggest that it may reduce birth weight (McKenna,2005).
To summarize, it is evident that clinicians and patients generally are cautious when prescribing or using antipsychotics during pregnancy, inadequately controlled psychiatric illness poses risks to both mother and child.
Cite this article as:
Abida Sajjad(2016) Are antipsychotics related to birth defects? The Beautiful Space-A Journal of Mind, Art and Poetry.. October 2016: TBSB105
1).Confidential Enquiry into Maternal and Child Health. Why Mothers Die 2000–2002: The Sixth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. London: RCOG Press; 2004.
2).Katherine L. Wisner, M.D., M.S. et al., JAMA Psychiatry, published online 17 August 2016.
3).McKenna K, Koren G, Tetelbaum M, et al. Pregnancy outcome of women using atypical antipsychotic drugs: A prospective comparative study. J Clin Psychiatry 2005;66:444–9.
4).JAMA Psychiatry. 2016;73(9):938-946. doi:10.1001/jamapsychiatry.2016.1520
Please check author names highlighted with each article.
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