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Callovini T, Montanari S, Bardi F, Barbonetti S, Rossi S, Caso R, Mandracchia G, Margoni S, Brugnami A, Paolini M, Manfredi G, Giudice LL, Segatori D, Zanzarri A, Onori L, Calderoni C, Benini E, Marano G, Massetti M, Fiaschè F, Di Segni F, Janiri D, Simonetti A, Moccia L, Grisoni F, Ruggiero S, Bartolucci G, Biscosi M, Ferrara OM, Bernardi E, Monacelli L, Giannico AM, De Berardis D, Battisti G, Ciliberto M, Brisi C, Lisci FM, D’Onofrio AM, Restaino A, Di Benedetto L, Anesini MB, Boggio G, Specogna E, Crupi A, De Chiara E, Caroppo E, Ieritano V, Monti L, Chieffo DPR, Rinaldi L, Camardese G, Cuomo I, Brugnoli R, Kotzalidis GD, Sani G, Mazza M. Obstetric Outcomes in Women on Lithium: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:4872. [PMID: 39201016 PMCID: PMC11355283 DOI: 10.3390/jcm13164872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/12/2024] [Accepted: 08/16/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: Lithium taken during pregnancy was linked in the past with increased risk for foetal/newborn malformations, but clinicians believe that it is worse for newborn children not to treat the mothers' underlying psychiatric illness. We set to review the available evidence of adverse foetal outcomes in women who received lithium treatment for some time during their pregnancy. Methods: We searched four databases and a register to seek papers reporting neonatal outcomes of women who took lithium during their pregnancy by using the appropriate terms. We adopted the PRISMA statement and used Delphi rounds among all the authors to assess eligibility and the Cochrane Risk-of-Bias tool to evaluate the RoB of the included studies. Results: We found 28 eligible studies, 10 of which met the criteria for inclusion in the meta-analysis. The studies regarded 1402 newborn babies and 2595 women exposed to lithium. Overall, the systematic review found slightly increased adverse pregnancy outcomes for women taking lithium for both the first trimester only and any time during pregnancy, while the meta-analysis found increased odds for cardiac or other malformations, preterm birth, and a large size for gestational age with lithium at any time during pregnancy. Conclusions: Women with BD planning a pregnancy should consider discontinuing lithium when euthymic; lithium use during the first trimester and at any time during pregnancy increases the odds for some adverse pregnancy outcomes. Once the pregnancy has started, there is no reason for discontinuing lithium; close foetal monitoring and regular blood lithium levels may obviate some disadvantages of lithium administration during pregnancy.
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Affiliation(s)
- Tommaso Callovini
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Silvia Montanari
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Francesca Bardi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Sara Barbonetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Sara Rossi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Romina Caso
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giuseppe Mandracchia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Stella Margoni
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Andrea Brugnami
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marco Paolini
- Department of Psychiatry, Università Vita-Salute San Raffaele, 20132 Milan, Italy;
| | - Giovanni Manfredi
- UOC Psichiatria, Sant’Andrea University Hospital, Università La Sapienza of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy;
| | - Luca Lo Giudice
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Daniele Segatori
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Andrea Zanzarri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Luca Onori
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Claudia Calderoni
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Elisabetta Benini
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giuseppe Marano
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marco Massetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Federica Fiaschè
- ASL RM1, Presidio Ospedaliero San Filippo Neri, Servizio Psichiatrico di Diagnosi e Cura, Via Giovanni Martinotti, 20, 00135 Rome, Italy;
| | - Federica Di Segni
- ASL Roma 2, Dipartimento di Salute Mentale, Servizio Per Le Dipendenze Patologiche Distretto 7, Via dei Sestili 7, 00174 Rome, Italy;
| | - Delfina Janiri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alessio Simonetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Lorenzo Moccia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Flavia Grisoni
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Sara Ruggiero
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giovanni Bartolucci
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marco Biscosi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Ottavia Marianna Ferrara
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Evelina Bernardi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Leonardo Monacelli
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alessandro Michele Giannico
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | | | - Giulia Battisti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Michele Ciliberto
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Caterina Brisi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Francesco Maria Lisci
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Antonio Maria D’Onofrio
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Antonio Restaino
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Luca Di Benedetto
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Maria Benedetta Anesini
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gianluca Boggio
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Elettra Specogna
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Arianna Crupi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Emanuela De Chiara
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Emanuele Caroppo
- Department of Mental Health, Local Health Authority Roma 2, 00159 Rome, Italy;
| | - Valentina Ieritano
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Laura Monti
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.M.); (D.P.R.C.)
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.M.); (D.P.R.C.)
- Department Women Children and Public Health, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Lucio Rinaldi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giovanni Camardese
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Ilaria Cuomo
- ASL RM1, UOC SM Distretto XIII ASL Roma 1, CSM Via Boccea 271271, 00168 Rome, Italy;
| | - Roberto Brugnoli
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Georgios D. Kotzalidis
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marianna Mazza
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
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Smith CJ, Payne VM. Epidemiology studies on effects of lithium salts in pregnancy are confounded by the inability to control for other potentially teratogenic factors. Hum Exp Toxicol 2024; 43:9603271241236346. [PMID: 38394684 DOI: 10.1177/09603271241236346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
INTRODUCTION In bipolar women who took lithium during pregnancy, several epidemiology studies have reported small increases in a rare fetal cardiac defect termed Ebstein's anomaly. METHODS Behavioral, environmental, and lifestyle-associated risk factors associated with bipolar disorder and health insurance status were determined from an Internet search. The search was conducted from October 1, 2023, through October 14, 2023. The search terms employed included the following: bipolar, bipolar disorder, mood disorders, pregnancy, congenital heart defects, Ebstein's anomaly, diabetes, hypertension, Medicaid, Medicaid patients, alcohol use, cigarette smoking, marijuana, cocaine, methamphetamine, narcotics, nutrition, diet, obesity, body mass index, environment, environmental exposures, poverty, socioeconomic status, divorce, unemployment, and income. No quotes, special fields, truncations, etc., were used in the searches. No filters of any kind were used in the searches. RESULTS Women who remain on lithium in the United States throughout their pregnancy are likely to be experiencing mania symptoms and/or suicidal ideation refractory to other drugs. Pregnant women administered the highest doses of lithium salts would be expected to have been insufficiently responsive to lower doses. Any small increases in the retrospectively determined risk of fetal cardiac anomalies in bipolar women taking lithium salts cannot be disentangled from potential developmental effects resulting from very high rates of cigarette smoking, poor diet, alcohol abuse, ingestion of illegal drugs like cocaine or opioids, marijuana smoking, obesity, and poverty. CONCLUSIONS The small risks in fetal cardiac abnormalities reported in the epidemiology literature do not establish a causal association for lithium salts and Ebstein's anomaly.
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Affiliation(s)
- Carr J Smith
- Department of Alzheimer's Section, Society for Brain Mapping and Therapeutics, Mobile, AL, USA
| | - Victoria M Payne
- Psychiatric Associates of North Carolina Professional Association, Raleigh, NC, USA
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Santos AVS, Cardoso DS, Takada SH, Echeverry MB. Prenatal exposition to haloperidol: A preclinical narrative review. Neurosci Biobehav Rev 2023; 155:105470. [PMID: 37984569 DOI: 10.1016/j.neubiorev.2023.105470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Abstract
Pre-existing maternal mental disorders may affect the early interactions between mother and baby, impacting the child's psychoemotional development. The typical antipsychotic haloperidol can be used during pregnancy, even with some restrictions. Its prescription is not limited to psychotic disorders, but also to other psychiatric conditions of high incidence and prevalence in the woman's fertile period. The present review focused on the preclinical available data regarding the biological and behavioral implications of embryonic exposure to haloperidol. The understanding of the effects of psychotropic drugs during neurodevelopment is important for its clinical aspect since there is limited evidence regarding the risks of antipsychotic drug treatment in pregnant women and their children. Moreover, a better comprehension of the mechanistic events that can be affected by antipsychotic treatment during the critical period of neurodevelopment may offer insights into the pathophysiology of neurodevelopmental disorders. The findings presented in this review converge to the existence of several risks associated with prenatal exposure to such medication and emphasize the need for further studies regarding its dimensions.
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Affiliation(s)
- Aline Valéria Sousa Santos
- Laboratory of Neuropharmacology and Motor Behavior, Center for Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, SP, Brazil
| | - Débora Sterzeck Cardoso
- Neurogenetics Laboratory, Center for Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, SP, Brazil
| | - Silvia Honda Takada
- Neurogenetics Laboratory, Center for Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, SP, Brazil
| | - Marcela Bermúdez Echeverry
- Laboratory of Neuropharmacology and Motor Behavior, Center for Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, SP, Brazil; Neuroscience Laboratory, School of Medicine, Universidad de Santander (UDES), Bucaramanga, Santander, Colombia.
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Kananen A, Bernhardsen GP, Lehto SM, Huuskonen P, Kokki H, Keski-Nisula L. Quetiapine and other antipsychotic medications during pregnancy: a 15-year follow-up of a university hospital birth register. Nord J Psychiatry 2023; 77:651-660. [PMID: 37149788 DOI: 10.1080/08039488.2023.2205852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/15/2023] [Accepted: 04/11/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To survey trends of antipsychotic use during pregnancy and examine the associations between the use of quetiapine or any antipsychotic and adverse obstetric and neonatal outcomes. METHODS Birth register study of 36,083 women who gave birth at Kuopio University Hospital, Finland, between 2002 and 2016. Obstetric and neonatal outcomes between women using quetiapine (N = 152) or any antipsychotic (N = 227) were compared to controls (N = 35,133). RESULTS Altogether 246 (0.7%) women used antipsychotic medications during pregnancy and 153 (62,2%) of these women used quetiapine. Antipsychotic usage increased from 0.4% to 1.0% during the 15-year follow-up. Women using antipsychotics were more likely to smoke, drink alcohol, use illicit drugs, use other psychotropic medications, and have higher pre-pregnancy body mass index. Quetiapine use was associated with higher risk of increased postpartum bleeding in vaginal delivery (aOR 1.65; 95%CI 1.13-2.42), prolonged neonatal hospitalization (≥5 days) (aOR 1.54; 95%CI 1.10-2.15), and higher placental to birth weight ratio (PBW ratio) (aB 0.009; 95%CI 0.002-0.016). Use of any antipsychotic was associated with a higher risk of gestational diabetes mellitus (aOR 1.64; 95%CI 1.19-2.27), increased postpartum bleeding in vaginal delivery (aOR 1.50; 95%CI 1.09-2.07), prolonged neonatal hospitalization (≥5 days) (aOR 2.07; 95%CI 1.57-2.73), and higher PBW ratio (aB 0.007; 95%CI 0.001-0.012). CONCLUSION The use of antipsychotic medications increased among Finnish pregnant women from 2002 to 2016. Pregnant women using antipsychotics appear to have a higher risk for some adverse pregnancy and birth outcomes and may benefit from more frequent maternity care follow-ups.
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Affiliation(s)
- Anniina Kananen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Guro Pauck Bernhardsen
- R&D department, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Soili Marianne Lehto
- R&D department, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Pasi Huuskonen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Finnish Institute of Occupational Health, Kuopio, Finland
| | - Hannu Kokki
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Leea Keski-Nisula
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
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Liu X, Kolding L, Momen N, Gasse C, Pedersen LH. Maternal antipsychotic use during pregnancy and congenital malformations. Am J Obstet Gynecol MFM 2023; 5:100950. [PMID: 37015311 DOI: 10.1016/j.ajogmf.2023.100950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Existing data may underestimate the potential teratogenic effects of prenatal antipsychotic exposure because of lacking data on miscarriages and induced abortions. OBJECTIVE This study aimed to present a comprehensive analysis based on information on pregnancies ending in termination, miscarriage, stillbirth, and live birth. STUDY DESIGN We conducted a population-based cohort study in Denmark of clinically recognized singleton pregnancies with the first-trimester scan performed from 2008 to 2017. We compared the risk of major malformations between pregnancies exposed to antipsychotics in the first trimester and unexposed pregnancies. In secondary analyses, the comparison was made with pregnancies of women who used antipsychotics before but not during pregnancy (discontinuers). We used weighted log-binomial regression to estimate adjusted prevalence ratios and propensity score fine stratifications for confounding control. We performed 4 sensitivity analyses, including a sibling-controlled analysis. RESULTS Of the 503,158 pregnancies, 1252 (0.2%) were of women who filled an antipsychotic prescription in the first trimester. Major malformations were present in 7.3% of antipsychotic-exposed pregnancies, 5.1% of unexposed pregnancies, and 6.0% of discontinuers' pregnancies. The adjusted prevalence ratio was 1.23 (95% confidence interval, 1.01-1.50) among exposed pregnancies compared with unexposed pregnancies. The prevalence ratio was attenuated to 1.14 (95% confidence interval, 0.88-1.48) compared with discontinuers and 1.08 (95% confidence interval, 0.47-2.49) in the sibling analysis. Similar findings were observed with cardiac malformations. Results were consistent for classes and individual antipsychotics, and remained robust across the 4 sensitivity analyses. CONCLUSION Our findings suggest limited or no overall teratogenic effect of first-trimester antipsychotic exposure. For individual antipsychotics, with estimations based on very few cases, further studies with sufficient sample sizes are warranted.
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Affiliation(s)
- Xiaoqin Liu
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark (Drs Liu and Momen).
| | - Line Kolding
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark (Drs Kolding and Pedersen)
| | - Natalie Momen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark (Drs Liu and Momen)
| | - Christiane Gasse
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Drs Gasse and Pedersen); Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark (Dr Gasse); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark (Dr Gasse)
| | - Lars Henning Pedersen
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark (Drs Kolding and Pedersen); Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Drs Gasse and Pedersen); Department of Biomedicine, Aarhus University, Aarhus, Denmark (Dr Pedersen)
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Risk of Major Malformations Following First-Trimester Exposure to Olanzapine: Preliminary Data From the Massachusetts General Hospital National Pregnancy Registry for Psychiatric Medications. J Clin Psychopharmacol 2023; 43:106-112. [PMID: 36825887 DOI: 10.1097/jcp.0000000000001665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
PURPOSE/BACKGROUND Since its US Food and Drug Administration approval in 1996, olanzapine has been one of the most commonly prescribed atypical antipsychotics, making a better understanding of its reproductive safety profile critical. The goal of the current analysis was to determine the risk of major malformations among infants exposed to olanzapine during pregnancy compared with a group of nonexposed infants. METHODS/PROCEDURES The National Pregnancy Registry for Psychiatric Medications is a prospective pharmacovigilance program in which pregnant women are enrolled and interviewed during pregnancy and the postpartum period. Labor and delivery and pediatric medical records were screened for evidence of major malformations followed by adjudication by a dysmorphologist blinded to medication exposure. Infants with first-trimester exposure to olanzapine were compared with controls without second-generation antipsychotic exposure. FINDINGS/RESULTS As of April 18, 2022, 2619 women have enrolled in the study. At the time of data extraction, 49 olanzapine-exposed infants and 1156 infants in the comparison group were eligible for these analyses. There were no major malformations associated with olanzapine exposure in the first trimester. The absolute risk for major malformations in the exposure group was 0.00% (95% confidence interval, 0.00-7.25) for olanzapine compared with 1.64% (95% confidence interval, 0.99-2.55) in the control group. IMPLICATIONS/CONCLUSIONS In this prospective cohort, no major malformations were associated with olanzapine exposure during the first trimester. Although these data are preliminary and cannot rule out more modest effects, they are nonetheless important, adding to the growing reproductive safety data for olanzapine.
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Kulkarni J, Gurvich C, Gilbert H, Worsley R, Li Q, Karimi L. The use of first and second-generation antipsychotic drugs and the potential to develop gestational diabetes mellitus among perinatal patients with psychosis. Schizophr Res 2023; 254:22-26. [PMID: 36758325 DOI: 10.1016/j.schres.2023.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
There is limited knowledge about the effects of antipsychotic exposure on the development of gestational diabetes mellitus (GDM) in women with mental illness. Studies have demonstrated an association between antipsychotic medications and metabolic problems such as weight gain and diabetes mellitus in non-pregnant patients with psychiatric disorders. GDM increases the risk of adverse maternal outcomes, including pregnancy-induced hypertension, antepartum and postpartum haemorrhage, and caesarean delivery. The National Register of Antipsychotic Medication in Pregnancy (NRAMP) is a prospective Australian cohort study that observed women who took antipsychotics during pregnancy. Data from 205 women were extracted for the final analysis and included women who took first or second-generation antipsychotics (FGA,SGA) during the first trimester of pregnancy (at minimum) and had a diagnosis of a psychotic disorder (n = 180). The comparison (non-exposed) group (n = 25) were women with psychosis who chose not to take any antipsychotic during the first trimester (at minimum). The comparison groups were not matched, although groups were homogenous in terms of sex, age range, diagnosis and perinatal status. The results of logistic regression analysis revealed that women who were exposed to FGAs, SGAs were seven and five times, respectively, more likely to develop GDM compared to non-exposed groups. When adjusted for confounding variables such as BMI and family history of diabetes, the potential of developing GDM decreased for women taking SGAs. In conclusion, the risk of developing GDM is lower in women taking SGAs compared with women taking FDAs. In addition, family history of diabetes and BMI adds to the risk.
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Affiliation(s)
- Jayashri Kulkarni
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia.
| | - Caroline Gurvich
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Heather Gilbert
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Roisin Worsley
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Qi Li
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia.
| | - Leila Karimi
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia
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Cohen LS, Church TR, Freeman MP, Gaccione P, Caplin PS, Kobylski LA, Arakelian M, Rossa ET, Chitayat D, Hernández-Díaz S, Viguera AC. Reproductive Safety of Lurasidone and Quetiapine: Update from the National Pregnancy Registry for Psychiatric Medications. J Womens Health (Larchmt) 2023; 32:452-462. [PMID: 36716275 DOI: 10.1089/jwh.2022.0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: Second-generation antipsychotics (SGAs), also called atypical antipsychotics, are common therapies for women with a spectrum of psychiatric disorders. No systematically ascertained human reproductive safety data are available for lurasidone, and prospective data for quetiapine are limited, making decisions regarding use of these medications during pregnancy complicated. Materials and Methods: The National Pregnancy Registry for Psychiatric Medications is a prospective cohort study designed to collect reproductive safety data relative to SGAs. Pregnant women aged 18-45 years, with psychiatric illness and prenatal psychotropic medication exposure completed three phone interviews during pregnancy and the postpartum period. Cases of presumed malformations are abstracted from medical records for adjudication by a teratologist blinded to medication exposure. Results: Of 2,293 women enrolled at the time of analysis, 134 in the lurasidone group, 264 in the quetiapine group, and 886 controls completed the postpartum interview and were therefore eligible for inclusion. Dropped or lost-to-follow-up participants (13%) and those currently pregnant were excluded. Participants were predominantly White, college-educated, and married (lurasidone = 88.1%, 76.9%, 77.6%; quetiapine = 89.8%, 71.2%, 75.0%; controls = 92.7%, 86.7%, 89.1%). Absolute risks of major malformations were 2.19% (lurasidone), 1.85% (quetiapine), and 1.77% (controls). Odds ratios comparing lurasidone and quetiapine with controls were 1.24 (95% confidence interval [CI] = 0.36-4.32) and 1.04 (95% CI = 0.38-2.85), respectively. Conclusions: No specific patterns of malformations were observed in infants exposed to the medications of interest. Lurasidone and quetiapine did not appear to be major teratogens, but further information is needed to refine risk estimates. Food and Drug Administration guidance underscores the importance of pregnancy registries. Clinical trial number: NCT01246765.
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Affiliation(s)
- Lee S Cohen
- Ammon Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Taylor R Church
- Ammon Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Marlene P Freeman
- Ammon Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Peter Gaccione
- Ammon Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Phoebe S Caplin
- Ammon Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren A Kobylski
- Ammon Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Miranda Arakelian
- Ammon Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ella T Rossa
- Ammon Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David Chitayat
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Adele C Viguera
- Ammon Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cleveland Clinic Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Lin HY, Lin FJ, Katz AJ, Wang IT, Wu CH. Antipsychotic Use in Early Pregnancy and the Risk of Maternal and Neonatal Complications. Mayo Clin Proc 2022; 97:2086-2096. [PMID: 36210203 DOI: 10.1016/j.mayocp.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/24/2022] [Accepted: 04/11/2022] [Indexed: 03/21/2023]
Abstract
OBJECTIVE To assess the association between antipsychotic use in early pregnancy and the risk of maternal and neonatal metabolic complications. METHODS We conducted a population-based retrospective cohort study (January 1, 2010, to December 31, 2016) using the Health and Welfare Database in Taiwan. Pregnant women (18 to 49 years of age) were grouped as antipsychotic users (ie, received oral antipsychotic monotherapy during the first 20 weeks of pregnancy) and nonusers. Antipsychotic users were further categorized into first-generation antipsychotic and second-generation antipsychotic users. Propensity score methods, including matching and inverse probability of treatment weighting, were used to balance covariates. Conditional logistic regression and Cox proportional hazards models were used to compare risks of maternal (gestational diabetes mellitus, preterm birth) and neonatal (low birth weight [LBW], macrosomia) outcomes. RESULTS Antipsychotic users had a notably higher risk of preterm birth compared with nonusers (adjusted HR, 1.29; 95% CI, 1.04 to 1.60), but the risk of gestational diabetes mellitus (HR, 1.21; 95% CI, 0.94 to 1.56), LBW (odds ratio [OR], 1.07; 95% CI, 0.84 to 1.37), and macrosomia (OR, 1.36; 95% CI, 0.63 to 2.92) did not differ between the two groups. Among women who received antipsychotics, the odds of LBW were significantly higher in second-generation antipsychotic users compared with first-generation antipsychotic users (adjusted OR, 1.32; 95% CI, 1.04 to 1.68). CONCLUSION This study found that using antipsychotics in early pregnancy did not result in a greater risk of metabolic complications both for mothers and newborns. For women requiring treatment with antipsychotics during pregnancy, they should be monitored for the risk of preterm birth and low infant birth weight.
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Affiliation(s)
- Hsuan-Yu Lin
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei City, Taiwan
| | - Fang-Ju Lin
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei City, Taiwan; Graduate Institute of Clinical Pharmacy and School of Pharmacy, College of Medicine, National Taiwan University; Department of Pharmacy, National Taiwan University Hospital
| | - Aaron J Katz
- Departments of Population Health and Radiation Oncology, University of Kansas School of Medicine, Kansas City, KS, USA; Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - I-Te Wang
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei City, Taiwan; Department of Obstetrics and Gynecology, Taipei Medical University Hospital
| | - Chung-Hsuen Wu
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei City, Taiwan.
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Heinonen E, Forsberg L, Nörby U, Wide K, Källén K. Neonatal morbidity after fetal exposure to antipsychotics: a national register-based study. BMJ Open 2022; 12:e061328. [PMID: 35768086 PMCID: PMC9244682 DOI: 10.1136/bmjopen-2022-061328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the admission rate to neonatal care and neonatal morbidity after maternal use of antipsychotics during pregnancy. DESIGN A population-based register study. SETTING Information on all singleton births between July 2006 and December 2017 in Sweden including data on prescription drugs, deliveries and infants' health was obtained from the Swedish Medical Birth Register, the Prescribed Drug Register and the Swedish Neonatal Quality Register. Exposed infants were compared with unexposed infants and with infants to mothers treated with antipsychotics before or after but not during pregnancy. PARTICIPANTS The cohort comprised a total of 1 307 487 infants, of whom 2677 (0.2%) were exposed to antipsychotics during pregnancy and 34 492 (2.6%) had mothers who were treated before/after the pregnancy. OUTCOME MEASURES The primary outcome was admission rate to neonatal care. Secondary outcomes were the separate neonatal morbidities. RESULTS Of the exposed infants, 516 (19.3%) were admitted to neonatal care compared with 98 976 (7.8%) of the unexposed infants (adjusted risk ratio (aRR): 1.7; 95% CI: 1.6 to 1.8), with a further increased risk after exposure in late pregnancy. The highest relative risks were seen for withdrawal symptoms (aRR: 17.7; 95% CI: 9.6 to 32.6), neurological disorders (aRR: 3.4; 95% CI: 2.4 to 5.7) and persistent pulmonary hypertension (aRR: 2.1; 95% CI: 1.4 to 3.1) when compared with unexposed infants. The absolute risks for these outcomes were however low among the exposed infants, 1.3%, 1.8% and 1.0%, respectively, and the relative risks were lower when compared with infants to mothers treated before/after the pregnancy. CONCLUSION Fetal exposure to antipsychotics was associated with an increased risk of neonatal morbidity. The effects in the exposed infants seem transient and predominantly mild, and these findings do not warrant discontinuation of a necessary treatment but rather increased monitoring of these infants. The increased risk of persistent pulmonary hypertension requires further studies.
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Affiliation(s)
- Essi Heinonen
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Lisa Forsberg
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Nörby
- Department of Clinical Sciences, Centre of Reproduction Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
- Health and Medical Care Administration, Region Stockholm, Stockholm, Sweden
| | - Katarina Wide
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Källén
- Department of Clinical Sciences, Centre of Reproduction Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
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Momen NC, Robakis T, Liu X, Reichenberg A, Bergink V, Munk-Olsen T. In utero exposure to antipsychotic medication and psychiatric outcomes in the offspring. Neuropsychopharmacology 2022; 47:759-766. [PMID: 34750566 PMCID: PMC8782838 DOI: 10.1038/s41386-021-01223-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/13/2021] [Accepted: 10/21/2021] [Indexed: 02/03/2023]
Abstract
Information on neurodevelopmental effects of antenatal exposure to antipsychotics is limited to 10 studies, all examining children up to 5 years of age or less. The paper aimed to investigate the association between in utero exposure to antipsychotics and psychiatric outcomes in children using Danish nationwide registers. In total, 9011 liveborn singletons born 1998-2015 in Denmark whose mothers took antipsychotic medication before pregnancy were identified. Children whose mothers continued to take antipsychotics during pregnancy were compared with children of mothers who discontinued antipsychotics before pregnancy. As a negative control, paternal antipsychotic use in the same window was investigated. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression for the primary outcome of psychiatric disorders, as well for subcategories of psychiatric disorders. In total, 9.9% of children in the discontinuation group and 11.0% of children in the continuation group received a psychiatric disorder diagnosis during follow-up. The adjusted HR for psychiatric disorders among offspring in the continuation group compared to the discontinuation group was 1.10 (95% CI 0.93-1.30). For antipsychotic use in the fathers, the HR was 1.05 (95% CI 0.89-1.24). The study does not provide evidence of increased risk of psychiatric disorders among children of women who continue antipsychotic treatment during pregnancy. This was observed after accounting for the underlying risk conferred by maternal psychiatric disorders. This suggests women who need to continue antipsychotic medications during pregnancy can do so without adverse psychiatric outcomes for offspring.
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Affiliation(s)
- Natalie C. Momen
- grid.7048.b0000 0001 1956 2722National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Thalia Robakis
- grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY USA
| | - Xiaoqin Liu
- grid.7048.b0000 0001 1956 2722National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Abraham Reichenberg
- grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY USA ,grid.59734.3c0000 0001 0670 2351Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY USA ,grid.59734.3c0000 0001 0670 2351The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA ,grid.59734.3c0000 0001 0670 2351Seaver Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Veerle Bergink
- grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY USA ,grid.5645.2000000040459992XDepartment of Psychiatry, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Trine Munk-Olsen
- grid.7048.b0000 0001 1956 2722National Centre for Register-based Research, Aarhus University, Aarhus, Denmark ,grid.452548.a0000 0000 9817 5300iPSYCH-Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722CIRRAU-Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
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Antipsychotic Use in Pregnancy: Patient Mental Health Challenges, Teratogenicity, Pregnancy Complications, and Postnatal Risks. Neurol Int 2022; 14:62-74. [PMID: 35076595 PMCID: PMC8788503 DOI: 10.3390/neurolint14010005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/11/2021] [Accepted: 09/15/2021] [Indexed: 02/01/2023] Open
Abstract
Pregnant women constitute a vulnerable population, with 25.3% of pregnant women classified as suffering from a psychiatric disorder. Since childbearing age typically aligns with the onset of mental health disorders, it is of utmost importance to consider the effects that antipsychotic drugs have on pregnant women and their developing fetus. However, the induction of pharmacological treatment during pregnancy may pose significant risks to the developing fetus. Antipsychotics are typically introduced when the nonpharmacologic approaches fail to produce desired effects or when the risks outweigh the benefits from continuing without treatment or the risks from exposing the fetus to medication. Early studies of pregnant women with schizophrenia showed an increase in perinatal malformations and deaths among their newborns. Similar to schizophrenia, women with bipolar disorder have an increased risk of relapse in antepartum and postpartum periods. It is known that antipsychotic medications can readily cross the placenta, and exposure to antipsychotic medication during pregnancy is associated with potential teratogenicity. Potential risks associated with antipsychotic use in pregnant women include congenital abnormalities, preterm birth, and metabolic disturbance, which could potentially lead to abnormal fetal growth. The complex decision-making process for treating psychosis in pregnant women must evaluate the risks and benefits of antipsychotic drugs.
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O'Sullivan DL, Byatt N, Dossett EC. Long-Acting Injectable Antipsychotic Medications in Pregnancy: A Review. J Acad Consult Liaison Psychiatry 2021; 63:53-60. [PMID: 34461296 DOI: 10.1016/j.jaclp.2021.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/15/2021] [Accepted: 08/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Long-acting injectable antipsychotic medications (LAIs) are an evidence-based treatment option for people with severe mental illness. While women with severe mental illness who are prescribed LAIs can become pregnant, there is a dearth of research examining the safety of these medication formulations during pregnancy. OBJECTIVE This article summarizes available literature on the use of LAIs in pregnancy to help inform clinical decisions and guide future research. METHODS PubMed literature searches were completed using combinations of keywords including "antipsychotic" and "long-acting injectable" or "depot," or generic or brand names of LAIs with "pregnancy." Pregnancy outcomes were compared across studies. RESULTS Twelve relevant case reports of 13 pregnancies were identified. Six cases did not report any negative birth or infant outcomes, including prematurity, infants being born small for gestational age, congenital anomalies, and extrapyramidal symptoms. No cases reported abnormal Apgar scores, infants being born large for gestational age, or negative long-term developmental outcomes after exposure to LAIs during pregnancy. Cesarean section rate was comparable to the general population. Specific adverse outcomes included one infant with multiple congenital anomalies, 3 infants with minor congenital anomalies, and one infant with possible extrapyramidal symptoms. One infant was born prematurely, one infant was born small for gestational age, and 2 infants were born both prematurely and small for gestational age. CONCLUSIONS There is little research specifically examining the use of LAIs in pregnancy, so risks must be extrapolated from studies on oral antipsychotics in pregnancy. While the few published case reports examining LAIs in pregnancy somewhat align with research examining oral antipsychotics, these findings are inconclusive due to the inherently limited nature of case reports. Further investigation into the use of LAIs in pregnancy is warranted.
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Affiliation(s)
- Deirdre L O'Sullivan
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Nancy Byatt
- Department of Psychiatry, UMass Medical School/UMass Memorial Health Care, Shrewsbury, MA
| | - Emily C Dossett
- Departments of Psychiatry and Biobehavioral Sciences and of Obstetrics/Gynecology, Keck School of Medicine at the University of Southern California, Los Angeles, CA
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Orsolini L, Sceusa F, Pompili S, Mauro A, Salvi V, Volpe U. Severe and persistent mental illness (SPMI) in pregnancy and breastfeeding: focus on second-generation long acting injectable antipsychotics. Expert Opin Drug Saf 2021; 20:1207-1224. [PMID: 33966552 DOI: 10.1080/14740338.2021.1928634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Introduction: Pregnant women and fetuses are more likely than ever to be exposed to antipsychotic drugs (APs) during pregnancy and postpartum period. Second-generation APs (SGA) are increasingly used among women in reproductive age. Key outcomes (i.e., congenital malformations, pregnancy and maternal outcomes, neonatal/infant risks, and developmental/long-term outcomes) following the exposure to APs remain limited in number and size and yield of inconsistent findings overall, particularly regarding long-acting injectable AP (LAI-APs) formulations.Areas covered: The review aims at providing a summary of current knowledge on potential risks and safety profile of LAI-APs during pregnancy and breastfeeding, specifically focusing on SGA.Expert opinion: The management of safety and tolerability of long-acting injectable AP (LAI-APs) is far from having solid scientific evidence. In fact, due to ethical reasons, there is a lack of randomized clinical trials that limits the reliability and generalizability of the available data on LAI-APs safety profile during the perinatal period, being limited in the scientific literature only to isolated case reports. Therefore, it seems to be important for the future pathways to perinatal mental health care, providing a network of specialized clinicians and systematically collecting data of pregnant/puerperal women on oral and/or LAI APs-therapy about mother and infant outcomes.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Francesca Sceusa
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Simone Pompili
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Antonella Mauro
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Virginio Salvi
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
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Wang Z, Wong ICK, Man KKC, Alfageh BH, Mongkhon P, Brauer R. The use of antipsychotic agents during pregnancy and the risk of gestational diabetes mellitus: a systematic review and meta-analysis. Psychol Med 2021; 51:1028-1037. [PMID: 31969198 DOI: 10.1017/s003329171900401x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Previous studies have found contradicting results with regard to the use of antipsychotics during pregnancy and the risk of gestational diabetes mellitus (GDM). We aimed to evaluate the association between antipsychotic use in pregnancy and GDM. METHODS A systematic literature search was conducted in PubMed, EMBASE, PsycINFO and Cochrane Library databases up to March 2019, for data from observational studies assessing the association between gestational antipsychotic use and GDM. Non-English studies, animal studies, case reports, conference abstracts, book chapters, reviews and summaries were excluded. The primary outcome was GDM. Estimates were pooled using a random effect model, with the I2 statistic used to estimate heterogeneity of results. Our study protocol was registered with PROSPERO number: CRD42018095014. RESULTS In total 10 cohort studies met the inclusion criteria in our systematic review with 6642 exposed and 1 860 290 unexposed pregnancies. Six studies were included in the meta-analysis with a pooled adjusted relative risk of 1.24 overall [95% confidence interval (CI) 1.09-1.42]. The I2 result suggested low heterogeneity between studies (I2 = 6.7%, p = 0.373). CONCLUSION We found that the use of antipsychotic medications during pregnancy is associated with an increased risk of GDM in mothers. However, the evidence is still insufficient, especially for specific drug classes. We recommend more studies to investigate this association for specific drug classes, dosages and comorbidities to help clinicians to manage the risk of GDM if initiation or continuation of antipsychotic prescriptions during pregnancy is needed.
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Affiliation(s)
- Z Wang
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - I C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China
| | - K K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China
| | - B H Alfageh
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - P Mongkhon
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - R Brauer
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
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16
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Wang Z, Brauer R, Man KKC, Alfageh B, Mongkhon P, Wong ICK. Prenatal exposure to antipsychotic agents and the risk of congenital malformations in children: A systematic review and meta-analysis. Br J Clin Pharmacol 2021; 87:4101-4123. [PMID: 33772841 DOI: 10.1111/bcp.14839] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/18/2021] [Accepted: 03/19/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the association between antipsychotic use in pregnancy and the risk of congenital malformations in children. DATA SOURCES Searches of PubMed, EMBASE, PsycINFO and Cochrane Library were conducted from inception to 06 January 2020 using keywords: antipsychotics, pregnancy, pregnancy complication and congenital abnormalities. STUDY SELECTION Of 38 reports initially identified as being of potential interest, 13 studies met our inclusion criteria: English observational studies that examined the association between gestational antipsychotic use and congenital malformations in children. DATA EXTRACTION Data were extracted independently by 2 investigators including the publication year, study site, study period, data source, study design, sample size, medication exposure, exposure period and pregnancy definition, exposure as well as outcome ascertainment, selection of study and comparison group, confounding adjustment, statistical analysis, and method of linkage between mother and children. Risk estimates were pooled using a random-effect model and the I2 statistic was used to evaluate the degree of heterogeneity. RESULTS Thirteen studies met our systematic review inclusion criteria. Six studies with a total of 2 515 272 pregnancy episodes were included in our meta-analysis, which provided a pooled adjusted risk ratio of 1.23, 95% confidence interval: 0.96-1.58. The I2 result showed moderate heterogeneity between studies (I2 = 35.2%, P = .173). CONCLUSION We did not find strong evidence of an association between prenatal exposure to antipsychotic medications and the risk of congenital malformations in children. We recommend further studies investigate this association, focusing on specific medication classes and dose responses, which would help clinicians decide whether to prescribe certain antipsychotics during pregnancy.
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Affiliation(s)
- Zixuan Wang
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Ruth Brauer
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Basmah Alfageh
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.,College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Pajaree Mongkhon
- School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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17
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Wang Z, Man KKC, Ma T, Howard LM, Wei L, Wong ICK, Brauer R. Association between antipsychotic use in pregnancy and the risk of gestational diabetes: Population-based cohort studies from the United Kingdom and Hong Kong and an updated meta-analysis. Schizophr Res 2021; 229:55-62. [PMID: 33243714 DOI: 10.1016/j.schres.2020.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/06/2020] [Accepted: 11/15/2020] [Indexed: 11/20/2022]
Abstract
AIMS To investigate whether exposure to antipsychotic medications during pregnancy is associated with gestational diabetes mellitus (GDM) in United Kingdom (UK) and Hong Kong (HK) population cohorts. METHODS Two population-based cohort studies were conducted using data from the UK The Health Improvement Network (THIN) and HK Clinical Data Analysis and Reporting System (CDARS). Nondiabetic women who received any type of antipsychotic medicine before their first pregnancy were included in our cohorts. The exposed group comprised women who continued using antipsychotics from the start of pregnancy to delivery (continuers), while the comparison group included women who were prescribed antipsychotics before the start of pregnancy but stopped during pregnancy (discontinuers). GDM was identified using GDM diagnosis and/or clinicians reported GDM. Odds ratios (ORs) with a 95% confidence interval (CI) were calculated to assess the association between antipsychotic use during pregnancy and GDM. Propensity Score fine-stratification weighting was used to adjust for potential confounding factors. RESULTS 3114 women with registered first pregnancies (2351 in THIN and 763 in CDARS) were included. 5.49% (2.55% in THIN and 14.55% in CDARS) were diagnosed with GDM. The adjusted OR of GDM in continuers was 0.73 (95% CI: 0.43-1.25) in THIN and 1.16 (95% CI: 0.78-1.73) in CDARS compared with discontinuers. CONCLUSIONS Our results do not suggest an increased risk of GDM in women who continued using antipsychotics during pregnancy compared to women who stopped. Based on these results, women should not stop their regular antipsychotics prescriptions in pregnancy due to the fear of GDM.
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Affiliation(s)
- Zixuan Wang
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tiantian Ma
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Louise M Howard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ruth Brauer
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom.
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Methodological Evaluation of Antipsychotic Use During Pregnancy and Gestational Diabetes Mellitus. J Clin Psychopharmacol 2021; 40:319-320. [PMID: 32332476 DOI: 10.1097/jcp.0000000000001211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dragoi AM, Radulescu I, Năsui BA, Pop AL, Varlas VN, Trifu S. Clozapine: An Updated Overview of Pharmacogenetic Biomarkers, Risks, and Safety-Particularities in the Context of COVID-19. Brain Sci 2020; 10:E840. [PMID: 33187329 PMCID: PMC7697202 DOI: 10.3390/brainsci10110840] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND clozapine (CLZ) use is precarious due to its neurological, cardiovascular, and hematological side effects; however, it is the gold standard in therapy-resistant schizophrenia (TRS) in adults and is underused. OBJECTIVE to examine the most recent CLZ data on (a) side effects concerning (b) recent pharmacological mechanisms, (c) therapy benefits, and (d) the particularities of the COVID-19 pandemic. DATA SOURCES a search was performed in two databases (PubMed and Web of Science) using the specific keywords "clozapine" and "schizophrenia", "side effects", "agranulocytosis", "TRS", or "bipolar affective disorder (BAF)" for the last ten years. STUDY ELIGIBILITY CRITERIA clinical trials on adults with acute symptoms of schizophrenia or related disorders. RESULTS we selected 37 studies, randomized controlled trials (RCTs), and clinical case series (CCS), centered on six main topics in the search area: (a) CLZ in schizophrenia, (b) CLZ in bipolar disorder, (c) side effects during the clozapine therapy, (d) CLZ in pregnancy, (e) CLZ in early-onset schizophrenia, and (f) CLZ therapy and COVID-19 infection. LIMITATIONS we considered RCTs and CCS from two databases, limited to the search topics. Conclusions and implications of key findings: (a) clozapine doses should be personalized for each patient based on pharmacogenetics testing when available; the genetic vulnerability postulates predictors of adverse reactions' severity; patients with a lower genetic risk could have less frequent hematological monitoring; (b) a CLZ-associated risk of pulmonary embolism imposes prophylactic measures for venous thromboembolism; (c) convulsive episodes are not an indication for stopping treatment; the plasma concentration of clozapine is a better side effect predictor than the dosage; (d) COVID-19 infection may enhance clozapine toxicity, generating an increased risk of pneumonia. Therapy must be continued with the proper monitoring of the white blood count, and the clozapine dose decreased by half until three days after the fever breaks; psychiatrists and healthcare providers must act together.
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Affiliation(s)
- Ana Miruna Dragoi
- Department of Psychiatry, “Alexandru Obregia” Clinical Hospital for Psychiatry, 10 Berceni St., 041914 Bucharest, Romania;
| | - Ioana Radulescu
- Department of General Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania; (I.R.); (V.N.V.)
| | - Bogdana Adriana Năsui
- Department of Community Health, “Iuliu Hațieganu” University of Medicine and Pharmacy, 6 Louis Pasteur St., 400349 Cluj-Napoca, Romania; or
| | - Anca Lucia Pop
- Department of Clinical Laboratory, Food Safety, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia St., 020945 Bucharest, Romania
| | - Valentin Nicolae Varlas
- Department of General Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania; (I.R.); (V.N.V.)
| | - Simona Trifu
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania;
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[Antipsychotics during pregnancy: a systematic review]. DER NERVENARZT 2020; 92:494-500. [PMID: 33000289 DOI: 10.1007/s00115-020-01006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The benefits and risks of treatment with antipsychotics during pregnancy must be weighed up carefully and individually because antipsychotics can penetrate the placental barrier and prescription is off-label. OBJECTIVE Evaluation of the risks and benefits of administering antipsychotics during pregnancy or for women who wish to become pregnant regarding teratogenic effects, risk of fetal death and stillbirths, perinatal complications, persisting postnatal impairments or disorders and gestational diabetes. METHODS A systematic review of the literature is provided to aid the selection of psychotropic drugs during pregnancy and in determining whether to begin, continue or switch an antipsychotic treatment during pregnancy. RESULTS Large, well-designed and controlled studies are missing; however, most studies suggest that the group of antipsychotics seem to be safe in terms of teratogenicity during pregnancy, at least in monotherapy. CONCLUSION Treating mental illnesses during pregnancy requires an individual assessment of the benefits and risks. The risk of an untreated mental illness versus the benefit of a suitable treatment with antipsychotics and the potential harm to the infant must be evaluated. If certain rules are observed and a suitable antipsychotic is selected the risk to the newborn child and/or mother during pregnancy can be minimized, however, a decision about subsequent medication can only be indirectly made from the results of this study.
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21
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Association Between Gestational Diabetes and Mental Illness. Can J Diabetes 2020; 44:566-571.e3. [PMID: 32792108 DOI: 10.1016/j.jcjd.2020.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022]
Abstract
The rates of both gestational diabetes mellitus (GDM) and mental illness in pregnancy are rising. There is an association between type 2 diabetes and major depressive disorder, anxiety and schizophrenia, thus there is a need for greater understanding of the relationship between GDM and mental illness. This review suggests that there is a bidirectional and complex relationship between antenatal depression, gestational diabetes and postpartum depression. The combined effect of both a history of depression and gestational diabetes significantly increases the risk of postpartum depression. There is an association between severe mental illness and GDM; however, it is strongly mediated by antipsychotic medications and psychosocial factors, in addition to the disease itself. Medication has a major role in treating mental illness during pregnancy and is not directly linked with GDM in either depression or psychosis. Health-care providers should be mindful of the association between GDM and mental illness to appropriately screen and treat both disorders.
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22
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Wilson CA, Newham J, Rankin J, Ismail K, Simonoff E, Reynolds RM, Stoll N, Howard LM. Is there an increased risk of perinatal mental disorder in women with gestational diabetes? A systematic review and meta-analysis. Diabet Med 2020; 37:602-622. [PMID: 31693201 PMCID: PMC7154542 DOI: 10.1111/dme.14170] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 01/24/2023]
Abstract
AIM Gestational diabetes (GDM) and mental disorder are common perinatal morbidities and are associated with adverse maternal and child outcomes. While there is a relationship between type 2 diabetes and mental disorder, the relationship between GDM and mental disorder has been less studied. We conducted a systematic review and meta-analysis of the prevalence of mental disorders in women with GDM and their risk for mental disorders compared with women without GDM. METHODS Published, peer-reviewed literature measuring prevalence and/or odds of GDM and perinatal mental disorders was reviewed systematically. Risk of bias was assessed using a checklist. Two independent reviewers were involved. Analyses were grouped by stage of peripartum, i.e. antepartum at the time of GDM diagnosis and after diagnosis, and in the postpartum. RESULTS Sixty-two studies were included. There was an increased risk of depressive symptoms in the antenatal period around the time of diagnosis of GDM [odds ratio (OR) 2.08; 95% confidence interval (CI) 1.42, 3.05] and in the postnatal period (OR 1.59; 95% CI 1.26, 2.00). CONCLUSIONS Given the potential relationship between GDM and perinatal mental disorders, integration of physical and mental healthcare in women experiencing GDM and mental disorders could improve short- and long-term outcomes for women and their children.
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Affiliation(s)
- C. A. Wilson
- Section of Women's Mental HealthKing's College London and South London and Maudsley NHS Foundation TrustLondonUK
| | - J. Newham
- Department of Primary Care and Public Health SciencesKing's College LondonLondonUK
| | - J. Rankin
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - K. Ismail
- Department of Psychological MedicineKing's College London and South London and Maudsley NHS Foundation TrustLondonUK
| | - E. Simonoff
- Department of Child and Adolescent PsychiatryKing's College London and South London and Maudsley NHS Foundation TrustLondonUK
| | - R. M. Reynolds
- Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - N. Stoll
- Department of Primary Care and Public Health SciencesKing's College LondonLondonUK
| | - L. M. Howard
- Section of Women's Mental HealthKing's College London and South London and Maudsley NHS Foundation TrustLondonUK
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Kucukgoncu S, Guloksuz S, Celik K, Bahtiyar MO, Luykx JJ, Rutten BPF, Tek C. Antipsychotic Exposure in Pregnancy and the Risk of Gestational Diabetes: A Systematic Review and Meta-analysis. Schizophr Bull 2020; 46:311-318. [PMID: 31167033 PMCID: PMC7442324 DOI: 10.1093/schbul/sbz058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND We have limited knowledge about the effects of antipsychotic exposure on the development of gestational diabetes mellitus (GDM). Aim of this study is to perform a systematic review and meta-analysis to assess GDM risk associated with antipsychotic exposure in pregnancy. METHODS Systematic literature search was performed using PubMed, Science Direct, Scopus, and Web of Science databases up to August 22, 2018. No restrictions to language or date were applied. Randomized, controlled trials, case-control, or cohort studies reporting GDM risk in antipsychotic-exposed, healthy controls or antipsychotic-ceased patients were included in the meta-analysis. The primary outcomes were study defined GDM, including number of events, odds ratios, and/or risk ratios (RR) with confidence intervals (CI). RESULTS Ten studies were included in the meta-analysis. The total number of subjects was 6213 for the antipsychotic-exposed group, 6836 for antipsychotic-ceased control group, and 1 677 087 for the healthy control group. Compared with the healthy controls, the unadjusted cumulative RR for GDM associated with antipsychotic use was 1.63 (95% CI = 1.20-2.22). Adjusted risk for GDM was significantly higher in antipsychotic exposure group than in healthy controls (RR = 1.30, 95% CI = 1.023-1.660). The adjusted RR for GDM was similar between the antipsychotic-exposed group and the antipsychotic-ceased group (RR = 0.78, 95% CI = 0.281-2.164). No significant association was found between study quality, smoking, alcohol use, gestational age, and cumulative GDM risk. DISCUSSION Our results indicate an increased risk of GDM with antipsychotic exposure in pregnant women, who may benefit from close pregnancy monitoring, early testing for GDM, targeting modifiable risk factors, and lifestyle modifications.
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Affiliation(s)
- Suat Kucukgoncu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT,To whom correspondence should be addressed; Department of Psychiatry, Yale University, 34 Park Street, Room 10, New Haven, CT 06519, US; tel: +1-203-974-7810, fax: +1-203-974-7502, e-mail:
| | - Sinan Guloksuz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT,Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht, The Nederlands
| | - Kubra Celik
- Faculty of Medicine Ankara, Yildirim Beyazit University, Ankara, Turkey
| | - Mert Ozan Bahtiyar
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Jurjen J Luykx
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Bart P F Rutten
- Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht, The Nederlands
| | - Cenk Tek
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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Anderson KN, Ailes EC, Lind JN, Broussard CS, Bitsko RH, Friedman JM, Bobo WV, Reefhuis J, Tinker SC. Atypical antipsychotic use during pregnancy and birth defect risk: National Birth Defects Prevention Study, 1997-2011. Schizophr Res 2020; 215:81-88. [PMID: 31761471 PMCID: PMC7036025 DOI: 10.1016/j.schres.2019.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/09/2019] [Accepted: 11/12/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE To examine the prevalence of, and factors associated with, atypical antipsychotic use among U.S. pregnant women, and potential associations between early pregnancy atypical antipsychotic use and risk for 14 birth defects. METHODS We analyzed data from the National Birth Defects Prevention Study (1997-2011), a U.S. population-based case-control study examining risk factors for major structural birth defects. RESULTS Atypical antipsychotic use during pregnancy was more common among women with pre-pregnancy obesity, and women who reported illicit drug use before and during pregnancy, smoking during pregnancy, alcohol use during pregnancy, or use of other psychiatric medications during pregnancy. We observed elevated associations (defined as a crude odds ratio [cOR] ≥2.0) between early pregnancy atypical antipsychotic use and conotruncal heart defects (6 exposed cases; cOR: 2.3, 95% confidence interval [CI]: 0.9-6.1), and more specifically Tetralogy of Fallot (3 exposed cases; cOR: 2.5, 95% CI: 0.7-8.8), cleft palate (4 exposed cases, cOR: 2.5, 95% CI: 0.8-7.6), anorectal atresia/stenosis (3 exposed cases, cOR: 2.8, 95% CI: 0.8-9.9), and gastroschisis (3 exposed cases, cOR: 2.1, 95% CI: 0.6-7.3). CONCLUSIONS Our findings support the close clinical monitoring of pregnant women using atypical antipsychotics. Women treated with atypical antipsychotics generally access healthcare services before pregnancy; efforts to reduce correlates of atypical antipsychotic use might improve maternal and infant health in this population.
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Affiliation(s)
- Kayla N Anderson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA.
| | - Elizabeth C Ailes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
| | - Jennifer N Lind
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA; United States Public Health Service, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
| | - Cheryl S Broussard
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
| | - Rebecca H Bitsko
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
| | - Jan M Friedman
- Department of Medical Genetics, University of British Columbia, 4500 Oak Street, Vancouver V6H 3N1, Canada
| | - William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, 4500 San Pablo Road S #378, Jacksonville, FL 32224, USA
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
| | - Sarah C Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
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Ellfolk M, Leinonen MK, Gissler M, Lahesmaa-Korpinen AM, Saastamoinen L, Nurminen ML, Malm H. Second-generation antipsychotics and pregnancy complications. Eur J Clin Pharmacol 2019; 76:107-115. [DOI: 10.1007/s00228-019-02769-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/20/2019] [Indexed: 12/14/2022]
Abstract
Abstract
Purpose
To study if second-generation antipsychotic (S-GA) use during pregnancy is associated with an increased risk of pregnancy and neonatal complications.
Methods
A population-based birth cohort study using national register data extracted from the “Drugs and Pregnancy” database in Finland, years 1996–2016. The sampling frame included 1,181,090 pregnant women and their singleton births. Women were categorized into three groups: exposed to S-GAs during pregnancy (n = 4225), exposed to first-generation antipsychotics (F-GAs) during pregnancy (n = 1576), and unexposed (no purchases of S-GAs or F-GAs during pregnancy, n = 21,125). Pregnancy outcomes in S-GA users were compared with those in the two comparison groups using multiple logistic regression models.
Results
Comparing S-GA users with unexposed ones, the risk was increased for gestational diabetes (adjusted odds ratio, OR 1.43; 95% CI 1.25–1.65), cesarean section (OR 1.35; 95% CI 1.18–1.53), being born large for gestational age (LGA) (OR 1.57; 95% CI 1.14–2.16), and preterm birth (OR 1.29; 95% CI 1.03–1.62). The risk for these outcomes increased further with continuous S-GA use. Infants in the S-GA group were also more likely to suffer from neonatal complications. Comparing S-GA users with the F-GA group, the risk of cesarean section and LGA was higher (OR 1.25, 95% CI 1.03–1.51; and OR 1.89, 95% CI 1.20–2.99, respectively). Neonatal complications did not differ between the S-GA and F-GA groups.
Conclusions
Prenatal exposure to S-GAs is associated with an increased risk of pregnancy complications related to impaired glucose metabolism. Neonatal problems are common and occur similarly in S-GA and F-GA users.
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Use of Prescribed Psychotropics during Pregnancy: A Systematic Review of Pregnancy, Neonatal, and Childhood Outcomes. Brain Sci 2019; 9:brainsci9090235. [PMID: 31540060 PMCID: PMC6770670 DOI: 10.3390/brainsci9090235] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022] Open
Abstract
This paper reviews the findings from preclinical animal and human clinical research investigating maternal/fetal, neonatal, and child neurodevelopmental outcomes following prenatal exposure to psychotropic drugs. Evidence for the risks associated with prenatal exposure was examined, including teratogenicity, neurodevelopmental effects, neonatal toxicity, and long-term neurobehavioral consequences (i.e., behavioral teratogenicity). We conducted a comprehensive review of the recent results and conclusions of original research and reviews, respectively, which have investigated the short- and long-term impact of drugs commonly prescribed to pregnant women for psychological disorders, including mood, anxiety, and sleep disorders. Because mental illness in the mother is not a benign event, and may itself pose significant risks to both mother and child, simply discontinuing or avoiding medication use during pregnancy may not be possible. Therefore, prenatal exposure to psychotropic drugs is a major public health concern. Decisions regarding drug choice, dose, and duration should be made carefully, by balancing severity, chronicity, and co-morbidity of the mental illness, disorder, or condition against the potential risk for adverse outcomes due to drug exposure. Globally, maternal mental health problems are considered as a major public health challenge, which requires a stronger focus on mental health services that will benefit both mother and child. More preclinical and clinical research is needed in order to make well-informed decisions, understanding the risks associated with the use of psychotropic medications during pregnancy.
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Breadon C, Kulkarni J. An update on medication management of women with schizophrenia in pregnancy. Expert Opin Pharmacother 2019; 20:1365-1376. [DOI: 10.1080/14656566.2019.1612876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Carolyn Breadon
- Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Australia
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Australia
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Højlund M, Pottegård A, Johnsen E, Kroken RA, Reutfors J, Munk-Jørgensen P, Correll CU. Trends in utilization and dosing of antipsychotic drugs in Scandinavia: Comparison of 2006 and 2016. Br J Clin Pharmacol 2019; 85:1598-1606. [PMID: 30927284 DOI: 10.1111/bcp.13945] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 03/04/2019] [Accepted: 03/23/2019] [Indexed: 01/20/2023] Open
Abstract
AIMS The aim of this study was to investigate time trends in dosing and prevalence of antipsychotic prescriptions in Scandinavia. METHODS We retrieved data on antipsychotic use between 2006 and 2016 from Danish, Norwegian and Swedish national prescription registers. For each antipsychotic, we calculated prevalence of use and mean doses, overall and for specific age groups (young, adults and elderly). RESULTS Antipsychotic use in Scandinavia increased from 16.5 to 17.2 users/1000 inhabitants between 2006 and 2016 (+2.4%, annual change: 0.07 users/1000 inhabitants/year, 95% CI: 0.02-0.20, P = 0.02). In 2006, chlorprothixene and levomepromazine were the most commonly used antipsychotics. By 2016, quetiapine was the most used antipsychotic in all three countries and across all age groups, with an overall 1-year prevalence of 4.05-9.97 users/1000 inhabitants (annual change: 0.57 users/1000 inhabitants/year, 95% CI: 0.54-0.60, P < 0.001). Quetiapine showed a marked decrease in mean doses during the 11-year study period (0.46-0.28 defined daily doses (DDD)/user/day: 39.1%, -0.02 DDD/user/day/year, 95% CI: -0.020 to -0.015, P < 0.001). In 2016, the highest mean doses were seen for clozapine (0.90-1.07 DDD/user/day) and olanzapine (0.66-0.88 DDD/user/day). CONCLUSIONS There is an increased prevalence of antipsychotic prescriptions that coincides with low and/or decreasing mean doses of the majority of commonly used antipsychotics in Scandinavia. Of all antipsychotics, this development was most pronounced for quetiapine. Reasons for and consequences of increased antipsychotic use that lasts shorter periods of time requires further study.
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Affiliation(s)
- Mikkel Højlund
- Department of Psychiatry Aabenraa, Mental Health Services Region of Southern Denmark, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anton Pottegård
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Erik Johnsen
- Division of Psychiatry and NORMENT, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rune A Kroken
- Division of Psychiatry and NORMENT, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Povl Munk-Jørgensen
- Department of Psychiatry Odense, Mental Health Services Region of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA.,Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Uguz F. Antipsychotic Use During Pregnancy and the Risk of Gestational Diabetes Mellitus: A Systematic Review. J Clin Psychopharmacol 2019; 39:162-167. [PMID: 30624301 DOI: 10.1097/jcp.0000000000001002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE This study aimed to review the current literature examining a potential relationship between the use of antipsychotic drugs during pregnancy and gestational diabetes mellitus (GDM). METHODS PubMed was searched for English language reports between January 1, 1996, and March 31, 2018, by using combinations of the following key words: antipsychotics, pregnancy, FGAs, SGAs, GDM, obstetric outcomes, pregnancy outcomes, obstetric complications, maternal complications, clozapine, olanzapine, risperidone, aripiprazole, amisulpirde, ziprasidone, quetiapine, haloperidol, chlorpromazine, zuclopenthixol, and flupenthixol. Studies but not case reports, case series, or reviews published in a peer-reviewed journal were eligible for inclusion. RESULTS A total of 10 relevant studies that met the review criteria were examined. Data from these studies indicated that the prevalence rates of GDM in pregnant women using antipsychotic drugs and the nomedication group were 2.6% to 22% and 0.95% to 10.7%, respectively. Most comparative studies reported that antipsychotic treatment during pregnancy was not significantly associated with increased in risk of GDM. In addition, the study results also suggested that underlying maternal psychopathologies might affect the risk of GDM. IMPLICATIONS Findings from some studies suggesting a higher risk of GDM in pregnant women who were administered antipsychotic drugs were not confirmed by results of many other studies. The current evidence suggests no significant relationship between antipsychotic drugs, including second- and first-generation antipsychotics, and the risk of GDM.
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Affiliation(s)
- Faruk Uguz
- From the Department of Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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30
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Abstract
Purpose of review Antipsychotics are frequently prescribed to women of childbearing age and are increasingly prescribed during pregnancy. A small, but growing, body of research on implications for pregnancy and infant outcomes is available to inform the risks and benefits of in utero exposure to antipsychotics. This review examines the existing published research on the use of common typical and atypical antipsychotics in pregnancy and the implications for pregnancy and infant outcomes. Recent findings The majority of studies do not show associations with major malformations and antipsychotic use in pregnancy, with the possible exception of risperidone. There is concern that atypical antipsychotics may be associated with gestational diabetes. Metabolic changes during pregnancy may necessitate dose adjustments. Summary In general, it is recommended that women who need to take an antipsychotic during pregnancy continue the antipsychotic that has been most effective for symptom remission. Further study on risperidone is needed to better understand its association with malformations and it is not considered a first-line agent for use during pregnancy.
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Affiliation(s)
- Hannah K Betcher
- Department of Psychiatry, Northwestern University Feinberg School of Medicine 676 N. St. Clair St. Ste 1000, Chicago, IL 60611, USA.,Mayo Clinic, Rochester, MN, USA
| | - Catalina Montiel
- Department of Psychiatry, Northwestern University Feinberg School of Medicine 676 N. St. Clair St. Ste 1000, Chicago, IL 60611, USA
| | - Crystal T Clark
- Department of Psychiatry, Northwestern University Feinberg School of Medicine 676 N. St. Clair St. Ste 1000, Chicago, IL 60611, USA.,Department of Obstetrics and Gynecology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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31
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Abstract
Bipolar disorder affects women throughout their childbearing years. During the perinatal period, women with bipolar disorder are vulnerable to depressive episode recurrences and have an increased risk for postpartum psychosis. Perinatal screening is critical to identify women at risk. Although medications are the mainstay of treatment, the choice of pharmacotherapy must be made by the patient based on a risk-benefit discussion with her physician. For optimal dosing in pregnancy, therapeutic drug monitoring may be required to maintain effective drug concentrations. Residual symptoms of bipolar depression are treatable with bright light therapy as an alternative to medication augmentation.
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Affiliation(s)
- Crystal T Clark
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 St. Clair Street, Chicago, IL 60611, USA.
| | - Katherine L Wisner
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 St. Clair Street, Chicago, IL 60611, USA
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Poels EMP, Bijma HH, Galbally M, Bergink V. Lithium during pregnancy and after delivery: a review. Int J Bipolar Disord 2018; 6:26. [PMID: 30506447 PMCID: PMC6274637 DOI: 10.1186/s40345-018-0135-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/10/2018] [Indexed: 12/16/2022] Open
Abstract
Lithium is an effective treatment in pregnancy and postpartum for the prevention of relapse in bipolar disorder. However, lithium has also been associated with risks during pregnancy for both the mother and the unborn child. Recent large studies have confirmed the association between first trimester lithium exposure and an increased risk of congenital malformations. Importantly, the risk estimates from these studies are lower than previously reported. Tapering of lithium during the first trimester could be considered but should be weighed against the risks of relapse. There seems to be no association between lithium use and pregnancy or delivery related outcomes, but more research is needed to be more conclusive. When lithium is prescribed during pregnancy, lithium blood levels should be monitored more frequently than outside of pregnancy and preferably weekly in the third trimester. We recommend a high-resolution ultrasound with fetal anomaly scanning at 20 weeks. Ideally, delivery should take place in a specialised hospital where psychiatric and obstetric care for the mother is provided and neonatal evaluation and monitoring of the child can take place immediately after birth. When lithium is discontinued during pregnancy, lithium could be restarted immediately after delivery as strategy for relapse prevention postpartum. Given the very high risk of relapse in the postpartum period, a high target therapeutic lithium level is recommended. Most clinical guidelines discourage breastfeeding in women treated with lithium. It is highly important that clinicians inform and advise women about the risks and benefits of remaining on lithium in pregnancy, if possible preconceptionally. In this narrative review we provide an up-to-date overview of the literature on lithium use during pregnancy and after delivery leading to clinical recommendations.
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Affiliation(s)
- Eline M P Poels
- Department of Psychiatry, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Hilmar H Bijma
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Megan Galbally
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Australia
| | - Veerle Bergink
- Department of Psychiatry, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands. .,Department of Psychiatry and Department of Obstetrics, Gynecology and Reproductive Science, The Blavatnik Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Room L4-34, New York City, NY, 10029, USA.
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Ward HB, Fromson JA, Cooper JJ, De Oliveira G, Almeida M. Recommendations for the use of ECT in pregnancy: literature review and proposed clinical protocol. Arch Womens Ment Health 2018; 21:715-722. [PMID: 29796968 DOI: 10.1007/s00737-018-0851-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
Abstract
Psychiatric disorders are common in pregnancy, affecting 15-29% of pregnant women. Untreated depression has negative health consequences for mother and fetus. Electroconvulsive therapy (ECT) is an effective option for the treatment of severe depression, high suicide risk, catatonia, medication-resistant illness, psychotic agitation, severe physical decline, and other life-threatening conditions. To our knowledge, however, there is no literature that consolidates all the evidence on maternal and fetal risks associated with untreated depression, medications, and ECT then translating it into one cohesive protocol that could serve as a management guide and a source of reassurance to health-care providers involved in such practice. Hoping to facilitate ECT access to perinatal patients, the authors combined their multidisciplinary clinical experience (in perinatal psychiatry, neuropsychiatry and neuromodulation, and anesthesiology) at three different centers in the USA (Brigham and Women's Hospital/Harvard Medical School, The University of Chicago, and Brown University) with a careful and critical literature review and propose guidelines for the administration of ECT in pregnancy. A comprehensive review of the relevant literature regarding both ECT and psychotropic medications in pregnancy was performed, including meta-analyses of randomized controlled trials published in general medicine, anesthesiology, psychiatry, and obstetrics journals and guidelines. The indication and appropriateness of ECT in pregnancy must be carefully weighed against the risks of untreated maternal illness and those of alternative treatment options. The safety of ECT in pregnancy has been documented over the last 50 years. The adverse effects in pregnancy are similar to the risks of ECT in any individual. The most common risk to the mother is premature contractions and preterm labor, which occur infrequently and are not clearly caused by ECT. The rates of miscarriages were not significantly different from that of the general population. There have been no associations of ECT with congenital anomalies, either morphologic or behavioral, and no neurocognitive disturbances in the child. ECT is a reasonably safe and effective treatment alternative for management of many psychiatric disorders in pregnant patients. The authors provide recommendations for treatment modifications in pregnancy-based physiologic changes that occur during that period and consolidate them into a protocol that can assist clinicians in improving access and safety of ECT for pregnant patients.
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Affiliation(s)
- Heather Burrell Ward
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - John A Fromson
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Joseph J Cooper
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Gildasio De Oliveira
- Hasbro Children's, Miriam and Newport Hospitals, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- The School of Public Health of Brown University, Providence, RI, USA
| | - Marcela Almeida
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Division of Women's Mental Health and Reproductive Psychiatry, Department of Psychiatry,, Harvard Medical School, 1153 Centre Street, Boston, MA, 02130, USA.
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34
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Poels EMP, Schrijver L, Kamperman AM, Hillegers MHJ, Hoogendijk WJG, Kushner SA, Roza SJ. Long-term neurodevelopmental consequences of intrauterine exposure to lithium and antipsychotics: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2018; 27:1209-1230. [PMID: 29948232 PMCID: PMC6133089 DOI: 10.1007/s00787-018-1177-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/31/2018] [Indexed: 12/14/2022]
Abstract
Lithium and antipsychotics are often prescribed to treat bipolar disorder or psychotic disorders in women of childbearing age. Little is known about the consequences of these medications during pregnancy for the developing child. The objective of this article is to systematically review findings from preclinical and clinical studies that have examined the neurodevelopmental consequences of intrauterine exposure to lithium and antipsychotics. A systematic search was performed in Embase, Medline, Web of Science, PsychINFO, Cochrane, and Google Scholar. Clinical and experimental studies were selected if they investigated neurodevelopment of offspring exposed to lithium or antipsychotics during gestation. Quality of clinical and preclinical studies was assessed by the Newcastle-Ottawa Scale and the SYRCLE's risk of Bias tool, respectively. In total, 73 studies were selected for qualitative synthesis and three studies were selected for quantitative synthesis. Of preclinical studies, 93% found one or more adverse effects of prenatal exposure to antipsychotics or lithium on neurodevelopment or behaviour. Only three clinical cohort studies have investigated the consequences of lithium exposure, all of which reported normal development. In 66% of clinical studies regarding antipsychotic exposure, a transient delay in neurodevelopment was observed. The relative risk for neuromotor deficits after in utero exposure to antipsychotics was estimated to be 1.63 (95% CI 1.22-2.19; I2 = 0%). Preclinical studies suggest long-term adverse neurodevelopmental consequences of intrauterine exposure to either lithium or antipsychotics. However, there is a lack of high-quality clinical studies. Interpretation is difficult, since most studies have compared exposed children with their peers from the unaffected population, which did not allow correction for potential influences regarding genetic predisposition or parental psychiatric illness.
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Affiliation(s)
- Eline M P Poels
- Department of Psychiatry, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Lisanne Schrijver
- Department of Psychiatry, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Astrid M Kamperman
- Department of Psychiatry, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Witte J G Hoogendijk
- Department of Psychiatry, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Steven A Kushner
- Department of Psychiatry, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Sabine J Roza
- Department of Psychiatry, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
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Forsberg L, Adler M, Römer Ek I, Ljungdahl M, Navér L, Gustafsson LL, Berglund G, Chotigasatien A, Hammar U, Böhm B, Wide K. Maternal mood disorders and lithium exposure in utero were not associated with poor cognitive development during childhood. Acta Paediatr 2018; 107:1379-1388. [PMID: 29150869 DOI: 10.1111/apa.14152] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/15/2017] [Accepted: 11/13/2017] [Indexed: 11/30/2022]
Abstract
AIM This study evaluated whether maternal mood disorders (MMD), particularly bipolar disorder, and lithium treatment during pregnancy influenced the neonatal health and cognition of children born from 2006 to 2010. METHODS Our study at Karolinska University Hospital, Stockholm, Sweden, focused on women with and without mood disorders and their children. Information on pharmacotherapy, mental health, delivery and neonatal complications was retrospectively collected from electronic patient records. Children were tested in a blinded manner at four to five years of age with the Wechsler Preschool and Primary Scale of Intelligence, 3rd edition. Maternal health, child health and social situations were evaluated. RESULTS Of the 39 children, 20 were exposed to lithium and MMD during pregnancy, eight were exposed to MMD but not lithium and 11 were not exposed to MMD or lithium. The children's full scale intelligence quotient (IQ), performance IQ and verbal IQ results did not differ significantly between the groups. The processing speed quotient was significantly lower in children exposed to mood disorders, but there was a high level of missing data for this subtest. CONCLUSION This small, clinical cohort showed no significant association between mothers' prenatal exposure to lithium or mood disorders and their offspring's IQ.
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Affiliation(s)
- L Forsberg
- Department of Pediatrics; Karolinska University Hospital; Stockholm Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC); Division of Pediatrics; Karolinska Institutet; Stockholm Sweden
| | - M Adler
- Affective disorder Outpatient Clinic; Psychiatric Clinic Southwest; Stockholm Sweden
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - I Römer Ek
- Affective disorder Outpatient Clinic; Psychiatric Clinic Southwest; Stockholm Sweden
| | - M Ljungdahl
- Affective disorder Outpatient Clinic; Psychiatric Clinic Southwest; Stockholm Sweden
| | - L Navér
- Department of Pediatrics; Karolinska University Hospital; Stockholm Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC); Division of Pediatrics; Karolinska Institutet; Stockholm Sweden
| | - LL Gustafsson
- Department of Laboratory Medicine; Division of Clinical Pharmacology; Karolinska Institutet; Stockholm Sweden
| | - G Berglund
- Department of Psychologists; Karolinska University Hospital Huddinge; Stockholm Sweden
| | - A Chotigasatien
- Department of Anesthesiology; Karolinska University Hospital; Stockholm Sweden
| | - U Hammar
- Institute of Environmental Medicine; Unit of Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - B Böhm
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - K Wide
- Department of Pediatrics; Karolinska University Hospital; Stockholm Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC); Division of Pediatrics; Karolinska Institutet; Stockholm Sweden
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Ritchie HE, Oakes DJ, Kennedy D, Polson JW. Early Gestational Hypoxia and Adverse Developmental Outcomes. Birth Defects Res 2018; 109:1358-1376. [PMID: 29105381 DOI: 10.1002/bdr2.1136] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/01/2017] [Indexed: 12/14/2022]
Abstract
Hypoxia is a normal and essential part of embryonic development. However, this state may leave the embryo vulnerable to damage when oxygen supply is disturbed. Embryofetal response to hypoxia is dependent on duration and depth of hypoxia, as well as developmental stage. Early postimplantation rat embryos were resilient to hypoxia, with many surviving up to 1.5 hr of uterine clamping, while most mid-gestation embryos were dead after 1 hour of clamping. Survivors were small and many had a range of defects, principally terminal transverse limb reduction defects. Similar patterns of malformations occurred when embryonic hypoxia was induced by maternal hypoxia, interruption of uteroplacental flow, or perfusion and embryonic bradycardia. There is good evidence that high altitude pregnancies are associated with smaller babies and increased risk of some malformations, but these results are complicated by increased risk of pre-eclampsia. Early onset pre-eclampsia itself is associated with small for dates and increased risk of atrio-ventricular septal defects. Limb defects have clearly been associated with chorionic villus sampling, cocaine, and misoprostol use. Similar defects are also observed with increased frequency among fetuses who are homozygous for thalassemia. Drugs that block the potassium current, whether as the prime site of action or as a side effect, are highly teratogenic in experimental animals. They induce embryonic bradycardia, hypoxia, hemorrhage, and blisters, leading to transverse limb defects as well as craniofacial and cardiovascular defects. While evidence linking these drugs to birth defects in humans is not compelling, the reason may methodological rather than biological. Birth Defects Research 109:1358-1376, 2017.© 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Helen E Ritchie
- Discipline of Biomedical Science, Sydney Medical School, University of Sydney, Sydney, NSW
| | - Diana J Oakes
- Discipline of Biomedical Science, Sydney Medical School, University of Sydney, Sydney, NSW
| | | | - Jaimie W Polson
- Discipline of Biomedical Science, Sydney Medical School, University of Sydney, Sydney, NSW
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Park Y, Hernandez-Diaz S, Bateman BT, Cohen JM, Desai RJ, Patorno E, Glynn RJ, Cohen LS, Mogun H, Huybrechts KF. Continuation of Atypical Antipsychotic Medication During Early Pregnancy and the Risk of Gestational Diabetes. Am J Psychiatry 2018; 175:564-574. [PMID: 29730938 PMCID: PMC5988929 DOI: 10.1176/appi.ajp.2018.17040393] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Some atypical antipsychotics are associated with metabolic side effects, which are risk factors for gestational diabetes. The authors examined the risk of developing gestational diabetes associated with the continuation of treatment with aripiprazole, ziprasidone, quetiapine, risperidone, and olanzapine during pregnancy compared with discontinuation of these antipsychotic drugs. METHOD Nondiabetic pregnant women who were linked to a live-born infant and enrolled in Medicaid (2000-2010) and who received one or more prescriptions dispensed for an antipsychotic drug during the 3 months before pregnancy were included in the analyses. Among 1,543,334 pregnancies, some expectant mothers at baseline were receiving treatment with aripiprazole (N=1,924), ziprasidone (N=673), quetiapine (N=4,533), risperidone (N=1,824), or olanzapine (N=1,425). For each antipsychotic drug, women with two or more dispensings ("continuers") were compared with women with no dispensings ("discontinuers") during the first half of pregnancy. A generalized linear model and propensity-score stratification were used to obtain absolute and relative risks of developing gestational diabetes, with adjustment for confounders. RESULTS Women who continued antipsychotic treatment during pregnancy generally had higher comorbidity and longer baseline antipsychotic use. The crude risk of developing gestational diabetes among continuers compared with discontinuers, respectively, was 4.8% and 4.5% for aripiprazole, 4.2% and 3.8% for ziprasidone, 7.1% and 4.1% for quetiapine, 6.4% and 4.1% for risperidone, and 12.0% and 4.7% for olanzapine. The adjusted relative risks were 0.82 (95% CI=0.50-1.33) for aripiprazole, 0.76 (95% CI=0.29-2.00) for ziprasidone, 1.28 (95% CI=1.01-1.62) for quetiapine, 1.09 (95% CI=0.70-1.70) for risperidone, and 1.61 (95% CI=1.13-2.29) for olanzapine. CONCLUSIONS Compared with women who discontinued use of an atypical antipsychotic medication before the start of pregnancy, women who continued treatment with olanzapine or quetiapine had an increased risk of gestational diabetes that may be explained by the metabolic effects associated with these two drugs.
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Affiliation(s)
- Yoonyoung Park
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Brian T. Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA,The Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Jacqueline M. Cohen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Rishi J. Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Robert J. Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Lee S. Cohen
- Center for Women’s Mental Health, Perinatal and Reproductive Psychiatry Program, Massachusetts General Hospital, Boston, MA
| | - Helen Mogun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Krista F. Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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Paulzen M, Goecke TW, Kuzin M, Augustin M, Gründer G, Schoretsanitis G. Pregnancy exposure to quetiapine - Therapeutic drug monitoring in maternal blood, amniotic fluid and cord blood and obstetrical outcomes. Schizophr Res 2018; 195:252-257. [PMID: 28965779 DOI: 10.1016/j.schres.2017.09.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/24/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
Abstract
RATIONALE This prospective study is the first to measure and correlate quetiapine concentrations in maternal blood, amniotic fluid and umbilical cord blood to account for the distribution of quetiapine. METHODS Concentrations of quetiapine are quantified in seven mother infant pairs at the time of delivery. Data are provided as median values, first (Q1) and third (Q3) quartiles and ranges. To account for the penetration ratio, the concentration of quetiapine in amniotic fluid and cord blood was divided by maternal concentrations. Correlations between daily dosage, maternal serum and umbilical cord blood concentrations were computed for seven patients while calculations for amniotic fluid were only available for six mother-infant pairs. RESULTS The median daily dosage of quetiapine was 300mg (Q1: 300mg, Q3: 600mg, range 200-800mg). There was a strong and significant correlation between maternal serum and cord blood concentrations (r=0.893, p=0.007). The median penetration ratio into fetal circulation was 0.18 (Q1: 0.16, Q3: 0.32; range 0.13-0.42), suggesting a low penetration. The median penetration ratio into amniotic fluid was 0.44 (Q1: 0.15, Q3: 0.96; range 0.09-1.70). CONCLUSIONS Quetiapine concentrations in amniotic fluid and cord blood give evidence that quetiapine is constantly accessible to the fetus with a relatively low penetration ratio. A high correlation between maternal serum and umbilical cord blood concentrations highlights a predictive role of quantifying drug concentrations in maternal serum for assessing drug concentrations in fetal circulation. Findings support the important role of therapeutic drug monitoring in supporting the efficacy and safety of psychopharmacological treatment strategies in highly vulnerable populations.
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Affiliation(s)
- Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; Alexianer Hospital Aachen, Germany; JARA - Translational Brain Medicine, Aachen, Germany.
| | - Tamme W Goecke
- Department of Gynecology and Obstetrics, RWTH Aachen University, Germany
| | - Maxim Kuzin
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Marc Augustin
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Gerhard Gründer
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; University Hospital of Psychiatry, Bern, Switzerland
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Damkier P, Videbech P. The Safety of Second-Generation Antipsychotics During Pregnancy: A Clinically Focused Review. CNS Drugs 2018; 32:351-366. [PMID: 29637530 DOI: 10.1007/s40263-018-0517-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The issue of antipsychotic treatment during pregnancy is subject to substantial uncertainty and some controversy among healthcare providers, specifically pertaining to second-generation antipsychotics (SGAs) that are subject to a large gap in safety data during pregnancy compared with antidepressants. The amount of safety data for the use of SGAs during pregnancy is rapidly increasing, thus constantly changing the level of evidence. We performed a clinically focused review on the safety of SGA during pregnancy. Twenty-three studies provided various pregnancy outcomes for 14,382 pregnant women exposed to an SGA during pregnancy. In utero exposure to aripiprazole, olanzapine, and quetiapine is not associated with increased risks of major congenital malformations, whereas risperidone and paliperidone may be associated with a very minor increased risk of congenital malformations. Safety data on ziprasidone and clozapine remain scarce and insufficient for a quantitative safety evaluation. No or minimal safety data are available for amisulpride, asenapine, lurasidone, and sertindole. For other pregnancy outcomes of interest, e.g. miscarriage, stillbirth, and small for gestational age, the available data overall do not suggest a clinically important increased risk, and do not allow for a meaningful stratification on individual drug level. Furthermore, for neonatal adaption and childhood neurodevelopment, the data do not allow for a meaningful risk assessment. It is imperative that factors in addition to safety data, e.g. individual disease history, characteristics and treatment response, adverse reaction profile, and patient preferences, be considered for the individual patient when choosing specific SGA treatment during pregnancy.
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Affiliation(s)
- Per Damkier
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Poul Videbech
- Center for Neuropsychiatric Depression Research, Mental Health Center Glostrup, Glostrup, Denmark
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Imaz ML, Oriolo G, Torra M, Soy D, García-Esteve L, Martin-Santos R. Clozapine Use During Pregnancy and Lactation: A Case-Series Report. Front Pharmacol 2018; 9:264. [PMID: 29636684 PMCID: PMC5881137 DOI: 10.3389/fphar.2018.00264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/09/2018] [Indexed: 12/16/2022] Open
Abstract
The current prescription of clozapine in psychotic women of reproductive age makes it crucial to understand its pharmacokinetics during pregnancy and lactation as well as its risk profile for neonatal outcome. The aim of this case series was to provide new evidence on the pharmacokinetic features of clozapine that determine its passage through the placenta and amniotic fluid, as well as the neonatal clozapine elimination half-life (t1/2). This case series demonstrates for the first time that clozapine might show partial placental passage similar to other atypical antipsychotics. Clozapine levels decreased during the first few days in nursing infants. The half-life of clozapine in neonates was slightly higher than previously estimated. Clozapine use in pregnancy may be associated with diabetes mellitus, especially if there is a family history of this disease. Although no acute toxicological effects were observed in the intrauterine exposed newborn, close follow-up of pregnancy is recommended. However, these results must be taken with caution being a case series with small sample size
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Affiliation(s)
- M Luisa Imaz
- Perinatal Psychiatry Program, Department of Psychiatry and Psychology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Giovanni Oriolo
- Department of Medicine, University of Barcelona, Barcelona, Spain.,Department of Psychiatry and Psychology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mercè Torra
- Department of Medicine, University of Barcelona, Barcelona, Spain.,Pharmacology and Toxicology Laboratory, Biochemistry and Molecular Genetics Service, Biomedical Diagnostic Center (CBD), Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Dolors Soy
- Division of Medicines, Pharmacy Service, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Lluïsa García-Esteve
- Perinatal Psychiatry Program, Department of Psychiatry and Psychology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Rocio Martin-Santos
- Department of Medicine, University of Barcelona, Barcelona, Spain.,Department of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigacions Biomèdiques Artur Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Barcelona, Spain
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Cuomo A, Goracci A, Fagiolini A. Aripiprazole use during pregnancy, peripartum and lactation. A systematic literature search and review to inform clinical practice. J Affect Disord 2018; 228:229-237. [PMID: 29275156 DOI: 10.1016/j.jad.2017.12.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 11/26/2017] [Accepted: 12/09/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aripiprazole is used relatively frequently in women with bipolar disorder or schizophrenia in childbearing years, owing to its efficacy and relatively favorable side effect profile. As is the case for other psychotropic medications, for ethical reasons, no prospective randomized placebo controlled trial to assess aripiprazole safety during pregnancy has ever been conducted. However, animal data are available and the amount of exposure and outcome data for human fetuses and infants has recently increased, providing published prospective safety data in relatively large numbers of pregnant women treated with aripiprazole. The aim of this study was to perform a systematic literature search and review to critically evaluate the available data on the use of aripiprazole during pregnancy, peripartum and lactation. METHODS PubMed, PsychInfo, and Cochrane Library were searched using the following search builder: (pregnancy OR pregnant OR gestation OR malformations OR perinatal OR reproduction OR organogenesis OR delivery OR breast-feeding OR lactation or peripartum or obstetric) AND aripiprazole. Reports that met the following pre-defined criteria were included in the present review: (1) published in English language in a peer-reviewed journal; (2) clearly defined use of aripiprazole during pregnancy and/or lactation and/or postpartum; (3) case report, case series, prospective, retrospective or cross-sectional studies. United States and European Medicine Agency prescribing information for aripiprazole were consulted as well and all the references of selected papers were cross checked for information pertaining to the use of aripiprazole during pregnancy, peripartum and lactation. RESULTS A total of 549 items published in a period ranging from 1995 to 2017, were retrieved from the search databases and reference cross check. One-hundred-fifty-three duplicate items were removed, 176 titles were deemed as not pertinent, 220 abstracts and 122 full-text articles were assessed for eligibility and 93 titles were included for qualitative synthesis. United States and European Medicine Agency prescribing information for aripiprazole were consulted and the selected manuscript references were cross checked. No randomized placebo controlled trial was found but relatively large prospective studies, large database studies, and several case reports and case studies were identified and summarized. CONCLUSIONS As is the case for other antipsychotics, definitive evidence on aripiprazole reproductive safety is lacking, but newer safety data are relatively reassuring. In many cases, the potential benefits of aripiprazole for patients with bipolar disorder or schizophrenia outweigh the potential risks.
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Affiliation(s)
- A Cuomo
- Department of Molecular Medicine, University of Siena School of Medicine, Siena 53100, Italy.
| | - A Goracci
- Department of Molecular Medicine, University of Siena School of Medicine, Siena 53100, Italy
| | - A Fagiolini
- Department of Molecular Medicine, University of Siena School of Medicine, Siena 53100, Italy
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Panchaud A, Hernandez-Diaz S, Freeman MP, Viguera AC, MacDonald SC, Sosinsky AZ, Cohen LS. Use of atypical antipsychotics in pregnancy and maternal gestational diabetes. J Psychiatr Res 2017; 95:84-90. [PMID: 28810177 DOI: 10.1016/j.jpsychires.2017.07.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/24/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Second generation antipsychotic medications (SGAs) are widely used by reproductive-age women to treat a number of psychiatric illnesses. Some SGAs have been associated with an increased risk of developing diabetes, although information regarding their diabetogenic effect in pregnant women is scarce. OBJECTIVE To evaluate the risk of gestational diabetes (GDM) among women treated with SGA. METHOD The Massachusetts General Hospital (MGH) National Pregnancy Registry for Atypical Antipsychotics (NPRAA) collects data on drug use, pregnancy outcomes, and other characteristics from pregnant women, ages 18-45 years, using 3 phone interviews conducted at (1) enrollment during pregnancy, (2) 7 months' gestation, and (3) 2-3 months postpartum. Information on GDM was abstracted from obstetric and delivery medical records. The study population was restricted to women without pre-gestational diabetes. Pregnancies exposed to SGAs during the first trimester were compared with a reference group of women with psychiatric conditions but not treated with SGAs during pregnancy. Generalized linear models were used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for GDM. RESULTS Of 303 women exposed to SGAs, 33 (10.9%) had GDM compared to 16 (10.7%) in the 149 non-exposed women. The crude OR of GDM for SGA was 1.02 (95% CI, 0.54-1.91). After adjustment for maternal age, race, marital status, employment status, level of education, smoking, and primary psychiatric diagnosis, the OR moved to 0.79 (0.40-1.56). CONCLUSIONS Findings did not suggest an increased risk of GDM associated with exposure to SGAs during pregnancy in women who had used SGA before pregnancy without developing diabetes, compared to psychiatrically ill women who were not exposed to SGA. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01246765.
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Affiliation(s)
- Alice Panchaud
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, USA.
| | - Sonia Hernandez-Diaz
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, USA
| | - Marlene P Freeman
- Ammon-Pinizzotto Center for Women's Mental Health, Department of Psychiatry Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Adele C Viguera
- Ammon-Pinizzotto Center for Women's Mental Health, Department of Psychiatry Massachusetts General Hospital, Harvard Medical School, Boston, USA; Cleveland Clinic, Cleveland Clinic Neurological Institute, Cleveland, OH, USA
| | - Sarah C MacDonald
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, USA
| | - Alexandra Z Sosinsky
- Ammon-Pinizzotto Center for Women's Mental Health, Department of Psychiatry Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Lee S Cohen
- Ammon-Pinizzotto Center for Women's Mental Health, Department of Psychiatry Massachusetts General Hospital, Harvard Medical School, Boston, USA
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43
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Smith B, Dubovsky SL. Pharmacotherapy of mood disorders and psychosis in pre- and post-natal women. Expert Opin Pharmacother 2017; 18:1703-1719. [DOI: 10.1080/14656566.2017.1391789] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Beth Smith
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
| | - Steven L. Dubovsky
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
- Departments of Psychiatry and Medicine, University of Colorado, Denver, CO, USA
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44
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Park Y, Huybrechts KF, Cohen JM, Bateman BT, Desai RJ, Patorno E, Mogun H, Cohen LS, Hernandez-Diaz S. Antipsychotic Medication Use Among Publicly Insured Pregnant Women in the United States. Psychiatr Serv 2017; 68:1112-1119. [PMID: 28617210 PMCID: PMC5665733 DOI: 10.1176/appi.ps.201600408] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Given the increasing use and broadening of indications for use of antipsychotic medications in the general population, as well as the paucity of information on the safety of this drug class during pregnancy, the study documented patterns of antipsychotic medication use among pregnant women. METHODS Medicaid Analytic eXtract data (2001-2010) from pregnant women who delivered live-born infants were used. Antipsychotic use at both the class and the individual drug level was defined based on dispensed outpatient prescriptions. Users' characteristics, including mental disorder diagnoses, were described. Temporal trends in use, as well as discontinuation patterns and psychotropic polytherapy, during pregnancy were evaluated. RESULTS Among 1,522,247 pregnancies, the prevalence of use of second-generation antipsychotics at any time during pregnancy increased threefold, from .4% to 1.3%, over the ten-year period, while the use of first-generation antipsychotics remained stable at around .1%. The increased use of second-generation antipsychotics was largely driven by more frequent use among patients with bipolar disorder. Quetiapine and aripiprazole were the most frequently dispensed drugs, and polytherapy with antipsychotics and antidepressants (65.2%), benzodiazepines (24.9%), and other mood stabilizers (22.0%) was common. More than 50% of women receiving an antipsychotic in the three months prior to pregnancy discontinued the drug during pregnancy. CONCLUSIONS A growing number of pregnant women in Medicaid are exposed to second-generation antipsychotics, frequently in combination with other psychotropic medications. This study highlights the importance of documenting the use and safety of these drugs during pregnancy to inform therapeutic decision making for pregnant women with psychiatric disorders.
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Affiliation(s)
- Yoonyoung Park
- Dr. Park, Dr. Huybrechts, Dr. Bateman, Dr. Desai, Dr. Patorno, and Ms. Mogun are with the Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Park is also with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, where Dr. Jacqueline Cohen and Dr. Hernandez-Diaz are affiliated. Dr. Bateman is also with the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Lee Cohen is with the Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Krista F Huybrechts
- Dr. Park, Dr. Huybrechts, Dr. Bateman, Dr. Desai, Dr. Patorno, and Ms. Mogun are with the Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Park is also with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, where Dr. Jacqueline Cohen and Dr. Hernandez-Diaz are affiliated. Dr. Bateman is also with the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Lee Cohen is with the Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Jacqueline M Cohen
- Dr. Park, Dr. Huybrechts, Dr. Bateman, Dr. Desai, Dr. Patorno, and Ms. Mogun are with the Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Park is also with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, where Dr. Jacqueline Cohen and Dr. Hernandez-Diaz are affiliated. Dr. Bateman is also with the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Lee Cohen is with the Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Brian T Bateman
- Dr. Park, Dr. Huybrechts, Dr. Bateman, Dr. Desai, Dr. Patorno, and Ms. Mogun are with the Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Park is also with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, where Dr. Jacqueline Cohen and Dr. Hernandez-Diaz are affiliated. Dr. Bateman is also with the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Lee Cohen is with the Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Rishi J Desai
- Dr. Park, Dr. Huybrechts, Dr. Bateman, Dr. Desai, Dr. Patorno, and Ms. Mogun are with the Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Park is also with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, where Dr. Jacqueline Cohen and Dr. Hernandez-Diaz are affiliated. Dr. Bateman is also with the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Lee Cohen is with the Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Elisabetta Patorno
- Dr. Park, Dr. Huybrechts, Dr. Bateman, Dr. Desai, Dr. Patorno, and Ms. Mogun are with the Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Park is also with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, where Dr. Jacqueline Cohen and Dr. Hernandez-Diaz are affiliated. Dr. Bateman is also with the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Lee Cohen is with the Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Helen Mogun
- Dr. Park, Dr. Huybrechts, Dr. Bateman, Dr. Desai, Dr. Patorno, and Ms. Mogun are with the Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Park is also with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, where Dr. Jacqueline Cohen and Dr. Hernandez-Diaz are affiliated. Dr. Bateman is also with the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Lee Cohen is with the Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Lee S Cohen
- Dr. Park, Dr. Huybrechts, Dr. Bateman, Dr. Desai, Dr. Patorno, and Ms. Mogun are with the Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Park is also with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, where Dr. Jacqueline Cohen and Dr. Hernandez-Diaz are affiliated. Dr. Bateman is also with the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Lee Cohen is with the Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Sonia Hernandez-Diaz
- Dr. Park, Dr. Huybrechts, Dr. Bateman, Dr. Desai, Dr. Patorno, and Ms. Mogun are with the Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Park is also with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, where Dr. Jacqueline Cohen and Dr. Hernandez-Diaz are affiliated. Dr. Bateman is also with the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr. Lee Cohen is with the Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital, Boston
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Affiliation(s)
- Sandeep Kumar Goyal
- Department of Psychiatry, Christian Medical College, Ludhiana, Punjab, India
| | - Atul Goel
- Department of Pediatrics, Christian Medical College, Ludhiana, Punjab, India
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Dilemma of treating schizophrenia during pregnancy: a Case series and a review of literature. BMC Psychiatry 2017; 17:311. [PMID: 28851326 PMCID: PMC5576383 DOI: 10.1186/s12888-017-1475-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The choice of antipsychotic treatment during pregnancy remains controversial, mainly due to a lack of exposure and outcome data. Randomized clinical trials are practically impossible due to ethical reasons. Our reports describe three cases of closely monitored female patients with schizophrenia who were treated with olanzapine during pregnancy. The novelty of reports is that all patients were previously treated with olanzapine long acting injectable (LAI) for an average period of 3.8 years. During the LAI treatment period they were in remission and then refused to continue with LAI mainly due to treatment modality (injectable administration). CASE PRESENTATION The patients were relatively young, diagnosed with schizophrenia and were previously successfully treated with long acting injectable. The women were pregnant for the first time. In two cases, the patients had become pregnant during remission and they continued treatment with oral olanzapine. In the third case, olanzapine treatment was initiated during admission for a relapse. CONCLUSIONS There are no controlled studies for the use of olanzapine therapy in pregnant women. More studies are needed to determine the effects of antipsychotics, including olanzapine, on pregnant women and the developing fetus. Schizophrenia relapse during pregnancy may expose the mother and the fetus to high risk if olanzapine is stopped. It is important to assess the risks and benefits of treating pregnant or breastfeeding women with antipsychotics, and weigh these against possible risks of anomalies and developmental problems to the fetus or child.
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Courty E, Gobalakichenane P, Garcia M, Muscat A, Kazakian C, Ledent T, Moldes M, Blondeau B, Mitanchez D, Buyse M, Fève B. Antenatal antipsychotic exposure induces multigenerational and gender-specific programming of adiposity and glucose tolerance in adult mouse offspring. DIABETES & METABOLISM 2017; 44:281-291. [PMID: 28729164 DOI: 10.1016/j.diabet.2017.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/17/2017] [Accepted: 06/14/2017] [Indexed: 12/22/2022]
Abstract
Second-generation antipsychotics (SGAs) are well known for their metabolic side effects in humans, including obesity and diabetes. These compounds are maintained during pregnancy to prevent the relapse of psychoses, but they readily diffuse across the placenta to the fetus, as documented with the widely-prescribed drug olanzapine (OLZ). However, observational studies have provided conflicting results on the potential impact of SGAs on fetal growth and body weight, and their effects on metabolic regulation in the offspring. For this reason, our study has tested whether antenatal exposure of CD1 mice to OLZ influenced metabolic outcomes in the offspring of the first (F1) and second (F2) generations. In F1 mice, OLZ antenatal treatment caused a decrease in neonatal body weight in both genders, an effect that persisted throughout life only in male animals. Interestingly, F1 female mice also displayed altered glucose homoeostasis. F2 mice, generated by mating normal males with F1 female mice exposed to OLZ during antenatal life, exhibited higher neonatal body weights which persisted only in F2 female animals. This was associated with expansion of fat mass and a concordant pattern of adipose tissue gene expression. Moreover, male and female F2 mice were glucose-intolerant. Thus, our study has demonstrated that antenatal OLZ exposure induces multigenerational and gender-specific programming of glucose tolerance in the offspring mice as adults, and points to the need for careful monitoring of children exposed to SGAs during pregnancy.
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Affiliation(s)
- E Courty
- Inserm, Saint-Antoine Research Center, Saint-Antoine Hospital, Sorbonne University, Pierre-and-Marie-Curie University Paris 06, 75012 Paris, France; Hospitalo-Universitary Institute, ICAN, 75013 Paris, France
| | - P Gobalakichenane
- Inserm, Saint-Antoine Research Center, Saint-Antoine Hospital, Sorbonne University, Pierre-and-Marie-Curie University Paris 06, 75012 Paris, France; Hospitalo-Universitary Institute, ICAN, 75013 Paris, France; Department of Neonatology, Armand-Trousseau Hospital, 75012 Paris, France
| | - M Garcia
- Inserm, Saint-Antoine Research Center, Saint-Antoine Hospital, Sorbonne University, Pierre-and-Marie-Curie University Paris 06, 75012 Paris, France; Hospitalo-Universitary Institute, ICAN, 75013 Paris, France
| | - A Muscat
- Inserm, Saint-Antoine Research Center, Saint-Antoine Hospital, Sorbonne University, Pierre-and-Marie-Curie University Paris 06, 75012 Paris, France; Hospitalo-Universitary Institute, ICAN, 75013 Paris, France
| | - C Kazakian
- Inserm, Saint-Antoine Research Center, Saint-Antoine Hospital, Sorbonne University, Pierre-and-Marie-Curie University Paris 06, 75012 Paris, France; Hospitalo-Universitary Institute, ICAN, 75013 Paris, France
| | - T Ledent
- Inserm, Saint-Antoine Research Center, Saint-Antoine Hospital, Sorbonne University, Pierre-and-Marie-Curie University Paris 06, 75012 Paris, France
| | - M Moldes
- Inserm, Saint-Antoine Research Center, Saint-Antoine Hospital, Sorbonne University, Pierre-and-Marie-Curie University Paris 06, 75012 Paris, France; Hospitalo-Universitary Institute, ICAN, 75013 Paris, France
| | - B Blondeau
- Inserm, Saint-Antoine Research Center, Saint-Antoine Hospital, Sorbonne University, Pierre-and-Marie-Curie University Paris 06, 75012 Paris, France; Hospitalo-Universitary Institute, ICAN, 75013 Paris, France
| | - D Mitanchez
- Inserm, Saint-Antoine Research Center, Saint-Antoine Hospital, Sorbonne University, Pierre-and-Marie-Curie University Paris 06, 75012 Paris, France; Hospitalo-Universitary Institute, ICAN, 75013 Paris, France; Department of Neonatology, Armand-Trousseau Hospital, 75012 Paris, France
| | - M Buyse
- Inserm, Saint-Antoine Research Center, Saint-Antoine Hospital, Sorbonne University, Pierre-and-Marie-Curie University Paris 06, 75012 Paris, France; Hospitalo-Universitary Institute, ICAN, 75013 Paris, France; Paris-Sud University, EA 4123, 92296 Châtenay-Malabry, France; Department of Pharmacy, Saint-Antoine Hospital, AP-HP, 75012 Paris, France
| | - B Fève
- Inserm, Saint-Antoine Research Center, Saint-Antoine Hospital, Sorbonne University, Pierre-and-Marie-Curie University Paris 06, 75012 Paris, France; Hospitalo-Universitary Institute, ICAN, 75013 Paris, France; Department of Endocrinology, Saint-Antoine Hospital, AP-HP, 75012 Paris, France.
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Signal of Miscarriage with Aripiprazole: A Disproportionality Analysis of the Japanese Adverse Drug Event Report Database. Drug Saf 2017; 40:1141-1146. [DOI: 10.1007/s40264-017-0560-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Patorno E, Huybrechts KF, Bateman BT, Cohen JM, Desai RJ, Mogun H, Cohen LS, Hernandez-Diaz S. Lithium Use in Pregnancy and the Risk of Cardiac Malformations. N Engl J Med 2017; 376:2245-2254. [PMID: 28591541 PMCID: PMC5667676 DOI: 10.1056/nejmoa1612222] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND There has been concern that exposure to lithium early in pregnancy may be associated with a marked increase in the risk of Ebstein's anomaly (a right ventricular outflow tract obstruction defect) in infants and overall congenital cardiac defects, but data are conflicting and limited. METHODS We conducted a cohort study involving 1,325,563 pregnancies in women who were enrolled in Medicaid and who delivered a live-born infant between 2000 and 2010. We examined the risk of cardiac malformations among infants exposed to lithium during the first trimester as compared with unexposed infants and, in secondary analyses, with infants exposed to another commonly used mood stabilizer, lamotrigine. Risk ratios and 95% confidence intervals were estimated with control for psychiatric and medical conditions, medications, and other potential confounders. RESULTS Cardiac malformations were present in 16 of the 663 infants exposed to lithium (2.41%), 15,251 of the 1,322,955 nonexposed infants (1.15%), and 27 of the 1945 infants exposed to lamotrigine (1.39%). The adjusted risk ratio for cardiac malformations among infants exposed to lithium as compared with unexposed infants was 1.65 (95% confidence interval [CI], 1.02 to 2.68). The risk ratio was 1.11 (95% CI, 0.46 to 2.64) for a daily dose of 600 mg or less, 1.60 (95% CI, 0.67 to 3.80) for 601 to 900 mg, and 3.22 (95% CI, 1.47 to 7.02) for more than 900 mg. The prevalence of right ventricular outflow tract obstruction defects was 0.60% among lithium-exposed infants versus 0.18% among unexposed infants (adjusted risk ratio, 2.66; 95% CI, 1.00 to 7.06). Results were similar when lamotrigine-exposed infants were used as the reference group. CONCLUSIONS Maternal use of lithium during the first trimester was associated with an increased risk of cardiac malformations, including Ebstein's anomaly; the magnitude of this effect was smaller than had been previously postulated. (Funded by the National Institute of Mental Health.).
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Affiliation(s)
- Elisabetta Patorno
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., B.T.B., R.J.D., H.M.), and the Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (J.M.C., S.H.-D.), and the Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital (L.S.C.) - all in Boston
| | - Krista F Huybrechts
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., B.T.B., R.J.D., H.M.), and the Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (J.M.C., S.H.-D.), and the Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital (L.S.C.) - all in Boston
| | - Brian T Bateman
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., B.T.B., R.J.D., H.M.), and the Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (J.M.C., S.H.-D.), and the Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital (L.S.C.) - all in Boston
| | - Jacqueline M Cohen
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., B.T.B., R.J.D., H.M.), and the Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (J.M.C., S.H.-D.), and the Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital (L.S.C.) - all in Boston
| | - Rishi J Desai
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., B.T.B., R.J.D., H.M.), and the Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (J.M.C., S.H.-D.), and the Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital (L.S.C.) - all in Boston
| | - Helen Mogun
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., B.T.B., R.J.D., H.M.), and the Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (J.M.C., S.H.-D.), and the Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital (L.S.C.) - all in Boston
| | - Lee S Cohen
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., B.T.B., R.J.D., H.M.), and the Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (J.M.C., S.H.-D.), and the Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital (L.S.C.) - all in Boston
| | - Sonia Hernandez-Diaz
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., B.T.B., R.J.D., H.M.), and the Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (J.M.C., S.H.-D.), and the Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital (L.S.C.) - all in Boston
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Heller HM, Ravelli ACJ, Bruning AHL, de Groot CJM, Scheele F, van Pampus MG, Honig A. Increased postpartum haemorrhage, the possible relation with serotonergic and other psychopharmacological drugs: a matched cohort study. BMC Pregnancy Childbirth 2017; 17:166. [PMID: 28577352 PMCID: PMC5457563 DOI: 10.1186/s12884-017-1334-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/18/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Postpartum haemorrhage is a major obstetric risk worldwide. Therefore risk factors need to be investigated to control for this serious complication. A recent systematic review and meta-analysis revealed that the use of both serotonergic and non-serotonergic antidepressants in pregnancy are associated with a higher risk of postpartum haemorrhage. However, use of antidepressants in pregnancy is often necessary because untreated depression in pregnancy is associated with adverse maternal and neonatal outcome, such as postpartum depression, preterm birth and dysmaturity. Therefore it is of utmost importance to unravel the possible association between postpartum haemorrhage and the use of serotonergic and other psychopharmacological medication during pregnancy. METHODS We performed a matched cohort observational study consecutively including all pregnant women using serotonergic medication (n = 578) or other psychopharmacological medication (n = 50) visiting two teaching hospitals in Amsterdam between 2010 and 2014. The incidence of postpartum haemorrhage in women using serotonergic medication or other psychopharmacological medication was compared with the incidence of postpartum haemorrhage in 641,364 pregnant women not using psychiatric medication selected from the database of the Netherlands Perinatal Registry foundation (Perined). Matching took place 1:5 for nine factors, i.e., parity, maternal age, ethnicity, socioeconomic status, macrosomia, gestational duration, history of postpartum haemorrhage, labour induction and hypertensive disorder. RESULTS Postpartum haemorrhage occurred in 9.7% of the women using serotonergic medication. In the matched controls this was 6.6% (p = 0.01). The adjusted odds ratio (aOR) before matching was 1.6 (95% CI 1.2-2.1) and after matching 1.5 (95% CI 1.1-2.1). Among the women using other psychopharmacological medication, the incidence of postpartum haemorrhage before matching was 12.0% versus 6.1% (p = 0.08) with OR 2.1 (95% CI 0.9-4.9), and after matching 12.1% versus 4.4% (p = 0.03) with aOR of 3.3 (95% CI 1.1-9.8). CONCLUSIONS Pregnant women using serotonergic medication have an increased risk of postpartum haemorrhage, but this high risk is also seen in pregnant women using other psychopharmacological medication. We suggest that this higher risk of postpartum haemorrhage could not only be explained by serotonin, but also by other mechanisms. An additional explanation could be the underlying psychiatric disorder.
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Affiliation(s)
- Hanna M Heller
- Department of Hospital Psychiatry, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Anita C J Ravelli
- Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Andrea H L Bruning
- Department of Pediatric Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Fedde Scheele
- Department of Obstetrics and Gynaecology, OLVG Hospital (West), Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Maria G van Pampus
- Department of Obstetrics and Gynaecology, OLVG Hospital (East), Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Hospital Psychiatry, OLVG Hospital (West), Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
- Department of Hospital Psychiatry, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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