TREATMENT OF SCHIZOPHRENIA IN PREGNANCY AND POSTPARTUM
Main Article Content
Keywords
Schizophrenia, pregnancy, breastfeeding, antipsychotic medication
Abstract
Background
The prime age of onset for schizophrenia in women is during the childbearing years from ages 25-35. 50- 60% of these women will become pregnant; fifty percent of these pregnancies will be unplanned or unwanted. Discontinuation of medication will likely lead to a relapse of the illness during pregnancy or postpartum. Although research on the safety of psychotropic medication during pregnancy and breastfeeding is limited, it is still necessary to make treatment recommendations based on the accumulated information of the best available studies.
Objectives
To give an overview of what is known about the risks/benefits of antipsychotic medications during pregnancy and postpartum and make treatment recommendations for pregnant schizophrenic women.
Methods
A review was done on Pubmed, Medline and Cochrane to locate any studies or articles addressing the safety and efficacy of antipsychotic medication use in pregnancy and during breastfeeding and treatment planning for pregnant schizophrenic women.
Results
The majority of antipsychotic medications used to treat schizophrenia appear to be relatively safe for use during pregnancy and breastfeeding.
Conclusions
There appears to be greater risk for the mother and the fetus/infant in not treating schizophrenia during pregnancy and postpartum. Recommendations are made about the treatment of schizophrenic women in order to achieve the best outcome for mother and baby.
References
1. Leung A, Chue P. Sex differences in schizophrenia, a review of the literature. Acta Psychiatr Scand 2000(Suppl);401:3-38.
2. Howard LM. Fertility and pregnancy in women with psychotic disorders. Eur J Obstet Gynecol Reprod Biol 2005;119:3-10.
3. Jarskog LE, Mattioli MA, Perkins DO, et al. First-episode psychosis in a managed care setting: clinical management and research. Am J Psychiatry 2000;157:878-884.
4. Robinson GE. Psychopharmacology in pregnancy and postpartum. Focus 2012;10(1);3- 14.
5. Barnes TRE and the Schizophrenia Consensus Group of the British Association for Psychopharmacology. Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2011;25:67-620.
6. Davis JM, Janicak PG, Singla A, Sharma RP. Maintenance antipsychotic medication. In: Barnes TRE, ed. Antipsychotic Drugs and Their Side-Effects New York: Academic Press, 1993:183-203.
7. Gilbert PL, Harris MJ, McAdams LA, Jeste DV. Neuroleptic withdrawal in schizophrenic patients. A review of the literature. Arch Gen Psychiatry 1995;52:173-188.
8. Viguera AC, Baldessarini RJ, Hegarty JD, van Kammen DP, Tohen M. Clinical risk following abrupt and gradual withdrawal of maintenance neuroleptic treatment. Arch Gen Psychiatry 1997;54: 49-55.
9. Nilsson E, Lichtenstein P, Cnattingius S, Murray RM, Hultman CM. Women with schizophrenia: pregnancy outcome and infant death among their offspring. Schizophr Res 2002;58:221-229.
10. Altshuler LL, Cohen L, Szuba MP, Burt Vk, Gitlin M, Mintz J. Pharmacologic management of psychiatric illness during pregnancy: dilemmas and guidelines. Am J Psychiatry 1996;153:592-606.
11. Einarson A. Antipsychotic medication (safety/risk) during pregnancy and breastfeeding. Curr Women’s Health Rev 2010:6:34-38.
12. Einarson A, Boskovic R. Use and safety of antipsychotic drugs during pregnancy. J Psychiatr Pract 2009;15:183-192.
13. Diav-Citrin O, Shechtman S, Ornoy S, et al. Safety of haloperidol and penfluridol in pregnancy: a multicentre, prospective controlled study. J Clin Psychiatry 2005;66:317-322.
14. Newham JJ, Thomas SH, MacRitchie K, McElhatton PR, McAllister-Williams RH. Birth weight of infants after maternal exposure to typical and atypical antipsychotics: prospective comparison study. Br J Psychiatry 2008;192:333-337.
15. Lin HC, Chen IJ, Chen YH, Lee HC, Wu FJ. Maternal schizophrenia and pregnancy outcome: Does the use of antipsychotics make a difference? Schizophr Res 2010;116:55-60.
16. Solt I, Ganadry S, Weiner Z. The effect of meperidine and promethazine on fetal heart rate indices during the active phase of labor. Isr Med Assoc J 2002;4:178-180.
17. Kohen D. Psychotropic medication in pregnancy. Adv Psychiatr Treat 2004;10:59-66.
18. Johnson KC, LaPrairie JL, Brennan PA, Stowe ZN, Newport J. Prenatal antipsychotic exposure and neuromotor performance during infancy. Arch Gen Psychiatry 2012;69:787-794.
19. Slone D, Siskind V, Heinonen OP, Monson RR, Kaufman DW, Shapiro S. Antenatal exposure to the phenothiazines in relation to congenital malformations, perinatal mortality rate, birth weight, and intelligence quotient score. Am J Obstet Gynecol 1977;128:486-488.
20. Kris EB. Children of mothers maintained on pharmacotherapy during pregnancy and postpartum. Curr Ther Res Clin 1965;7:785-789.
21. Stika L, Elisova K, Honzakova L, et al. Effects of drug administration in pregnancy on children’s school behaviour. Pharm Weekbl Sci 1990;12:252-255.
22. Kulkarni J, McCauley-Elsom K, Marston M, et al. Preliminary findings from the National Register of Antipsychotic Medications in Pregnancy. Aust N Z J Psychiatry 2008;42:38- 44.
23. Goldstein DJ, Corbin LA, Fung MC. Olanzapine-exposed pregnancies and lactation: early experience. J Clin Psychopharm 2004;20:399-403.
24. McCauley-Elsom K, Gurvich C, Elsom SJ, Kulkarni J. Antipsychotics in pregnancy. J Psychiatric Ment Health Nurs 2010;17:97-104.
25. Yaeger D, Smith HG, Altshuler LL. Atypical antipsychotics in the treatment of schizophrenia during pregnancy and the postpartum. Am J Psychiatry 2006;163:2064-2070.
26. McKenna K, Koren G, Tetelbaum M, et al. Pregnancy outcome of women using atypical antipsychotic drugs: a prospective comparative study. J Clin Psychiatry 2005;66:444-449.
27. Anderson JL, Waller DK, Canfield MA, Shaw GM, Watkins ML, Werler MM. Maternal obesity, gestational diabetes, and central nervous system birth defects. Epidemiology 2005;16:87- 92.
28. Menon SJ. Psychotropic medication during pregnancy and lactation. Arch Gynecol Obstet 2008;277:1-13.
29. Gentile S. Antipsychotic therapy during early and late pregnancy: A systematic review. Schizophr Bull 2010;36:518-544.
30. Reis M, Kallen B. Maternal use of antipsychotics in early pregnancy and delivery outcome. J Clin Psychopharmacol 2008;28:279- 288.
31. Newport DJ, Calamaras MR, DeVane CL, et al. Atypical antipsychotic administration during late pregnancy: placental passage and obstetrical outcomes. Am J Psychiatry 2007;164:1214- 1220.
32. McElhatton PR. The effects of benzodiazepine use during pregnancy and lactation. Reprod Toxicol 1994;8:46-75.
33. Wang LH, Lin HC, Lin CC, Chen YH, Lin HC. Increased risk of adverse pregnancy outcomes in women receiving zolpidem during pregnancy. Clin Pharmacol Ther 2010;88:369-374.
34. Mcneil TF. A prospective study of postpartum psychoses in a high-risk group, 1. Clinical characteristics of the current postpartum episodes. Acta Psychiatr Scand 1986;74:205- 216.
35. Gentile S. Infant safety with antipsychotic therapy in breast-feeding: a systematic review. J Clin Psychiatry 2000;69:666-673.
36. Malone K, Papagni K, Ramini S, Keltner NL. Antidepressants, antipsychotics, benzodiazepines, and the breastfeeding dyad. Perspect Psychiatr Care 2004;40:73-85.
37. Dennis CL, Ross LE, Grigoriadis S. Psychosocial and psychological interventions for treating antenatal depression (review). The Cochrane Library. Mississauga, Ontario: John Wiley & Sons, Ltd; 2010(6).
38. Wisner KL, Perel JM, Wheeler SB. Tricyclic dose requirements across pregnancy. Am J Psychiatry 1993;150:1541-1542.
39. American Academy of Pediatrics Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:137-150.
2. Howard LM. Fertility and pregnancy in women with psychotic disorders. Eur J Obstet Gynecol Reprod Biol 2005;119:3-10.
3. Jarskog LE, Mattioli MA, Perkins DO, et al. First-episode psychosis in a managed care setting: clinical management and research. Am J Psychiatry 2000;157:878-884.
4. Robinson GE. Psychopharmacology in pregnancy and postpartum. Focus 2012;10(1);3- 14.
5. Barnes TRE and the Schizophrenia Consensus Group of the British Association for Psychopharmacology. Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2011;25:67-620.
6. Davis JM, Janicak PG, Singla A, Sharma RP. Maintenance antipsychotic medication. In: Barnes TRE, ed. Antipsychotic Drugs and Their Side-Effects New York: Academic Press, 1993:183-203.
7. Gilbert PL, Harris MJ, McAdams LA, Jeste DV. Neuroleptic withdrawal in schizophrenic patients. A review of the literature. Arch Gen Psychiatry 1995;52:173-188.
8. Viguera AC, Baldessarini RJ, Hegarty JD, van Kammen DP, Tohen M. Clinical risk following abrupt and gradual withdrawal of maintenance neuroleptic treatment. Arch Gen Psychiatry 1997;54: 49-55.
9. Nilsson E, Lichtenstein P, Cnattingius S, Murray RM, Hultman CM. Women with schizophrenia: pregnancy outcome and infant death among their offspring. Schizophr Res 2002;58:221-229.
10. Altshuler LL, Cohen L, Szuba MP, Burt Vk, Gitlin M, Mintz J. Pharmacologic management of psychiatric illness during pregnancy: dilemmas and guidelines. Am J Psychiatry 1996;153:592-606.
11. Einarson A. Antipsychotic medication (safety/risk) during pregnancy and breastfeeding. Curr Women’s Health Rev 2010:6:34-38.
12. Einarson A, Boskovic R. Use and safety of antipsychotic drugs during pregnancy. J Psychiatr Pract 2009;15:183-192.
13. Diav-Citrin O, Shechtman S, Ornoy S, et al. Safety of haloperidol and penfluridol in pregnancy: a multicentre, prospective controlled study. J Clin Psychiatry 2005;66:317-322.
14. Newham JJ, Thomas SH, MacRitchie K, McElhatton PR, McAllister-Williams RH. Birth weight of infants after maternal exposure to typical and atypical antipsychotics: prospective comparison study. Br J Psychiatry 2008;192:333-337.
15. Lin HC, Chen IJ, Chen YH, Lee HC, Wu FJ. Maternal schizophrenia and pregnancy outcome: Does the use of antipsychotics make a difference? Schizophr Res 2010;116:55-60.
16. Solt I, Ganadry S, Weiner Z. The effect of meperidine and promethazine on fetal heart rate indices during the active phase of labor. Isr Med Assoc J 2002;4:178-180.
17. Kohen D. Psychotropic medication in pregnancy. Adv Psychiatr Treat 2004;10:59-66.
18. Johnson KC, LaPrairie JL, Brennan PA, Stowe ZN, Newport J. Prenatal antipsychotic exposure and neuromotor performance during infancy. Arch Gen Psychiatry 2012;69:787-794.
19. Slone D, Siskind V, Heinonen OP, Monson RR, Kaufman DW, Shapiro S. Antenatal exposure to the phenothiazines in relation to congenital malformations, perinatal mortality rate, birth weight, and intelligence quotient score. Am J Obstet Gynecol 1977;128:486-488.
20. Kris EB. Children of mothers maintained on pharmacotherapy during pregnancy and postpartum. Curr Ther Res Clin 1965;7:785-789.
21. Stika L, Elisova K, Honzakova L, et al. Effects of drug administration in pregnancy on children’s school behaviour. Pharm Weekbl Sci 1990;12:252-255.
22. Kulkarni J, McCauley-Elsom K, Marston M, et al. Preliminary findings from the National Register of Antipsychotic Medications in Pregnancy. Aust N Z J Psychiatry 2008;42:38- 44.
23. Goldstein DJ, Corbin LA, Fung MC. Olanzapine-exposed pregnancies and lactation: early experience. J Clin Psychopharm 2004;20:399-403.
24. McCauley-Elsom K, Gurvich C, Elsom SJ, Kulkarni J. Antipsychotics in pregnancy. J Psychiatric Ment Health Nurs 2010;17:97-104.
25. Yaeger D, Smith HG, Altshuler LL. Atypical antipsychotics in the treatment of schizophrenia during pregnancy and the postpartum. Am J Psychiatry 2006;163:2064-2070.
26. McKenna K, Koren G, Tetelbaum M, et al. Pregnancy outcome of women using atypical antipsychotic drugs: a prospective comparative study. J Clin Psychiatry 2005;66:444-449.
27. Anderson JL, Waller DK, Canfield MA, Shaw GM, Watkins ML, Werler MM. Maternal obesity, gestational diabetes, and central nervous system birth defects. Epidemiology 2005;16:87- 92.
28. Menon SJ. Psychotropic medication during pregnancy and lactation. Arch Gynecol Obstet 2008;277:1-13.
29. Gentile S. Antipsychotic therapy during early and late pregnancy: A systematic review. Schizophr Bull 2010;36:518-544.
30. Reis M, Kallen B. Maternal use of antipsychotics in early pregnancy and delivery outcome. J Clin Psychopharmacol 2008;28:279- 288.
31. Newport DJ, Calamaras MR, DeVane CL, et al. Atypical antipsychotic administration during late pregnancy: placental passage and obstetrical outcomes. Am J Psychiatry 2007;164:1214- 1220.
32. McElhatton PR. The effects of benzodiazepine use during pregnancy and lactation. Reprod Toxicol 1994;8:46-75.
33. Wang LH, Lin HC, Lin CC, Chen YH, Lin HC. Increased risk of adverse pregnancy outcomes in women receiving zolpidem during pregnancy. Clin Pharmacol Ther 2010;88:369-374.
34. Mcneil TF. A prospective study of postpartum psychoses in a high-risk group, 1. Clinical characteristics of the current postpartum episodes. Acta Psychiatr Scand 1986;74:205- 216.
35. Gentile S. Infant safety with antipsychotic therapy in breast-feeding: a systematic review. J Clin Psychiatry 2000;69:666-673.
36. Malone K, Papagni K, Ramini S, Keltner NL. Antidepressants, antipsychotics, benzodiazepines, and the breastfeeding dyad. Perspect Psychiatr Care 2004;40:73-85.
37. Dennis CL, Ross LE, Grigoriadis S. Psychosocial and psychological interventions for treating antenatal depression (review). The Cochrane Library. Mississauga, Ontario: John Wiley & Sons, Ltd; 2010(6).
38. Wisner KL, Perel JM, Wheeler SB. Tricyclic dose requirements across pregnancy. Am J Psychiatry 1993;150:1541-1542.
39. American Academy of Pediatrics Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:137-150.