 |
 |
 |
|
|
There is a need to evaluate the safety of antipsychotic medications during pregnancy and lactation. Women with schizophrenia have sexual practices similar to those of demographically matched control subjects with respect to frequency of sex and the age at which they become sexually active. They are, however, more likely to have unplanned pregnancies (1). Unplanned pregnancies among women with schizophrenia and among women taking antipsychotics during their reproductive years expose developing infants to these medications. Given this situation, physicians need information to advise women with schizophrenia about the relative risks of exposing developing infants to antipsychotic medications and to help them to weigh those risks against the potential risks they and their infant may incur if their psychotic illness is not treated. It is important to limit treatment of mothers and exposed infants to situations in which the risk from the untreated psychotic illness is presumed to exceed the risk associated with drug treatment. MethodsWe conducted a computerized Medline search for the period between January 1, 1966, and December 1, 2001. We used the following key words: pregnancy, postpartum, lactation, breast-feeding, child development, infant development, schizophrenia, psychosis, antipsychotic, clozapine, olanzapine, risperidone, and quetiapine. The resultant articles were cross-referenced for other relevant articles not identified in the initial search. Pregnancy Outcome for Women With SchizophreniaIn 1960, Sobel found that women diagnosed with a psychotic illness were twice as likely as women in the general population to have a pregnancy resulting in congenital malformation or death, irrespective of chlorpromazine exposure during pregnancy (2). Other researchers reported a higher rate of perinatal death in the offspring of mothers with schizophrenia—a rate not statistically associated with exposure to typical antipsychotic medication (3). Subsequent literature reviews concluded that births to parents with schizophrenia did not carry increased risk for poor obstetrical outcomes (4,5). However, when metaanalysis was used to systematically examine the data reviewed in these studies, there was evidence of a small but significantly increased risk for low birth weight and poor neonatal condition in infants born to patients with schizophrenia (6). A Danish 20-year retrospective review found increased risk of preterm delivery, low birth weight, and small size for gestational age in newborn children of women with schizophrenia (7). These parameters for poor obstetrical outcome were chosen because they can be clearly defined and are strongly correlated with increased infant morbidity, mortality, and neurodevelopmental impairment (8). Previously, Bennedsen had reviewed the literature and found that women with schizophrenia have higher prevalence rates of cigarette smoking, alcohol use, drug use, and low socioeconomic status (9)—all of which are strongly associated in the general population with low birth weight, preterm birth, and perinatal death. This recent literature clarifies that women with schizophrenia are at increased risk for poor obstetrical outcomes and that many factors may contribute to this. It is in this context that one must evaluate studies looking at the extent to which, if any, antipsychotic medication exposure during infant development contributes to poor obstetrical outcomes in the population with schizophrenia. No antipsychotic medication has been approved for use during pregnancy and lactation, and the risks of infant exposure must be weighed against the risks of untreated maternal illness. The potential risks to the infant of medication exposure at this time include congenital abnormalities, neonatal toxicity, and long-term neurobehavioural sequelae.
|
||||||