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Clinical and Research News
Pregnancy May Not Negate Use Of Antipsychotic Medication
Psychiatric News
Volume 42 Number 1 page 25-30

For those with psychotic disorders, finding the right medication or combination of medication can be a trying endeavor fraught with periodic episodes of illness and medication side effects. Add pregnancy to the mix, and treatment success may become even more elusive as concerns for the health of the developing fetus take a prominent role in treatment considerations.

According to researchers, maternal mental health doesn't necessarily have to come at the expense of newborns' health. A pre-conception evaluation allows couples to formulate a plan "to minimize exposure of the fetus to unnecessary medications as well as preventing possible recurrence of psychiatric illness that may ensure from medications changes," according to a clinical case conference in the December 2006 American Journal of Psychiatry.

Deborah Yaeger, M.D., lead author of the article, told Psychiatric News, "The decision to use medications during pregnancy should always be driven by a risk-benefit assessment that weighs the risks of the mother of being off medications against the potential risk to fetal exposure of the medication."

Yaeger is a clinical professor of psychiatry at the UCLA David Geffen School of Medicine and director of psychiatric services at the Women's Comprehensive Care Center of the VA Greater Los Angeles Healthcare System.

In the article, Yaeger presented the case of a 38-year-old married woman who had schizophrenia and wished to become pregnant. During an earlier pregnancy, "Ms. A" elected to end the pregnancy after being told that the quetiapine could be harmful to the fetus. Ms. A's psychiatric consultation consisted of a detailed psychiatric and medical history followed by an in-depth discussion of the risks and benefits of medication use during pregnancy and postpartum.

Given Ms. A's history of severe psychosis and suicide attempts, it was decided if she became pregnant again, she should remain on medications during pregnancy and possibly through lactation.

According to the article, many women with psychotic disorders have children. However, mothers with schizophrenia are more likely than those without it to be unmarried and have limited social support.

According to a study by Laura Miller, M.D., appearing in the Fall 1997 Schizophrenia Bulletin, the majority of mothers with schizophrenia in one sample experienced loss of custody and their children are placed in foster care.

In addition, Yaeger cited a study led by Lori Altshuler, M.D., in the May 1996 American Journal of Psychiatry showing that women with schizophrenia tended to receive less prenatal care, have poorer nutrition, and use more tobacco, alcohol, and illicit drugs compared with women without schizophrenia. "These exposures may be far worse than psychiatric medications," Yaeger pointed out.

In addition, there appears to be increasing evidence about the risks that psychosis itself poses to pregnancy, Yaeger noted.

Emma Nilsson, Ph.D., and colleagues found that women who experienced a psychotic episode during pregnancy had twice the rate of adverse pregnancy outcomes—including stillbirth, fetal death, and premature delivery—as compared with those who did not have a psychotic episode. Her study was published in the December 2002 Schizophrenia Research.

When weighing the risks and benefits of medication during pregnancy, psychiatrists usually turn to the literature to find data on the effects of certain medications on pregnancy outcomes. But in the case of antipsychotic medications and pregnancy, not much information is available. However, it is known that common side effects of second generation antipsychotic medications include weight gain, hypertension, and diabetes, the article pointed out, which can complicate pregnancy.

One way to potentially diminish this risk is for physicians to assist patients taking atypical antipsychotics to limit weight gain both before and during pregnancy, Yaeger said. Having women participate in weight-management support groups and providing them financial assistance to purchase healthy foods might improve pregnancy outcomes both for mother and baby, she added.

In addition, it may be helpful for physicians treating pregnant women with psychotic disorders to ensure that the women are receiving ancillary services such as high-risk obstetrical care, social work appointments, and frequent psychiatric re-evaluations, Yaeger noted.

"Atypical Antipsychotics in the Treatment of Schizophrenia During Pregnancy and the Postpartum" is posted on the Web at<ajp.psychiatryonline.org/cgi/content/full/163/12/2064>.

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