Bruk av atypiske antipsykotika hos gravide: Balansering mellom risiko for ubehandlet sykdom og risiko for bivirkninger: Systematisk oversikt

A Systematized Review of Atypical Antipsychotics in Pregnant Women: Balancing Between Risks of Untreated Illness and Risks of Drug-Related Adverse Effects

Forfattere
Tosato, S. Albert, U. Tomassi, S. Iasevoli, F. Carmassi, C. Ferrari, S. Nanni, M. G. Nivoli, A. Volpe, U. Atti, A. R. Fiorillo, A.
Årstall
2017
Tidsskrift
Journal of Clinical Psychiatry
Volum
78
Sider
e477-e489
OBJECTIVE: To summarize risks related to (1) illness and (2) second-generation antipsychotic (SGA) treatment in pregnant women and their offspring. Concerning illness-related risks, we focused on bipolar disorder and schizophrenia, psychiatric disorders for which SGAs are preferentially prescribed. DATA SOURCES: PubMed, Ovid, Scopus, PsycINFO, and Cochrane Library were searched from the date of the first available article to October 2015 using the following key terms: pregnancy OR gestation OR bipolar disorder OR schizophrenia. We also included cross-references from identified articles. STUDY SELECTION: We included 49 English-language articles regarding illness-related and SGA-related risks in bipolar disorder and schizophrenia. First, searches were done for epidemiologic or experimental studies (from January 2000 to October 2015), then for systematic reviews and meta-analyses. DATA EXTRACTION: Data were extracted independently, after removing duplicates and studies that were not relevant or not pertinent. RESULTS: Abrupt discontinuation of treatment-exposed mothers with bipolar disorder or schizophrenia led to a high risk of relapses during pregnancy. Both bipolar disorder and schizophrenia were linked to a slightly increased risk of obstetric complications for mothers (schizophrenia) and the newborn (bipolar disorder and schizophrenia), although data on drug exposure during pregnancy were not given in the majority of studies. Maternal morbidity (schizophrenia but not bipolar disorder) may be associated with the worst neonatal outcomes (stillbirth, neonatal or infant deaths, and intellectual disability). Untreated bipolar disorder and schizophrenia may be considered independent risk factors for congenital malformations, while SGAs were not associated with increased recurring defects in fetuses. Evidence regarding the potential effects of SGAs on child neurodevelopment remains reassuring. CONCLUSION: After taking into account the parents' will and after they provide informed consent, the most reasonable and less harmful choice for treating future mothers with bipolar disorder or schizophrenia appears to be maintaining them at the safest minimum dosage.

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Tiltaksnivå

Behandling og hjelpetiltak

Tema

Utvikling og livsmestring

Kognisjon (hukommelse, oppmerksomhet, eksekutive funksjoner)

Biologiske risikofaktorer, sykdommer og symptomer

Gravide (inkl. tenåringsmødre)

Tiltak

Medikamentell behandling

Antipsykotisk medisin

Psykososiale hjelpetiltak

Tiltak rettet mot gravide og barselkvinner

Aldersgruppe

Sped- og småbarn (0-2 år)

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