July 06, 2005

More on Pregnancy & Atypical Antipsychotics

Atypical antipsychotics; Drugs, Pregnancy, and Lactation

In the past we've discussed the use of antipsychotics during pregnancy:

Recently, a new article discusses this issue in detail by also considering the reproductive safety of newer atypical antipsychotics. Initially, the article discusses older typical antipsychotics, stating that such drugs have been proven to be "safe" in the area of tetragenic risk - the risk associated with substances such as chemicals or radiation which have the potential to cause abnormal development of an embryo.

However, the article points out that much less data exists on the reproductive safety of newer atypical antipsychotics. Atypical antipsychotics have become more popular (as compared to typical antipsychotics) because they cause different and in some cases "less severe" side effects than the older drugs. Since the newer drugs are used not only to treat schizophrenia and sometimes acute mania, but also to treat different states of psychiatric diseases such as anxiety, agitation, etc., the examination of their effects on an embryo seems to be a useful one:

A study published in April--the first prospective study of the reproductive safety of the atypicals in the literature--provides some reassuring data regarding the risk of malformations, albeit in a relatively small sample. Investigators from the Motherisk Program in Toronto prospectively followed 151 women who took olanzapine, risperidone, quetiapine, or dozapine during pregnancy. All had taken one of these agents during the first trimester, and 48 were exposed throughout pregnancy. A total of 151 pregnant women who had taken a nonteratogenic drug also were followed. In the atypical-exposed group, one child was born with a major malformation (0.9%), a rate lower than the 1%-3% background rate; compared with two (1.5%) babies in the control group, an insignificant difference.Differences between groups in the rate of spontaneous abortions, still births, or gestational age at birth were not statistically significant. Women taking atypical antipsychotics did have significantly higher rates of low-birthweight babies (10% vs. 2%) and therapeutic abortions (10% vs. 1%) (J. Clin. Psychiatry 2005;66:444-9).

As stated above, the data gathered was from a small sample. Thus, it seems that repeating the study might be beneficial to drawing any solid conclusions. Nevertheless, the main conclusion drawn seemed to be that the discontinuation of medication may be appropriate if the patient "can do without it." However, decisions depend on the uniqueness of each patient and their situation. The author of the article did state however, that a person who suffers from a psychiatric disorder and is planning a pregnancy may want to switch from an atypical antipsychotic to a typical antipsychotic. Further, the author of the article states that "...often...women who present when they are already pregnant and on an atypical agent. At this point a switch may not be the wisest decision, if she is at a risk of relapse." As usual, please consult your physician before making any changes in medication.

Title of Article: "Atypical antipsychotics; Drugs, Pregnancy, and Lactation"
Author: Dr. Lee S. Cohen
Date: June 15, 2005

Antipsychotic Medication Info:


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