Long–term Neurodevelopment outcomes to Prenatal Antipsychotic Medication Exposure: Systemic Review

Abstract

Introduction

Peak incidence for many psychiatric disorders occurs in reproductive years. We don’t have FDA-approved drugs or clinical guidelines. The main cause of pharmacological suspension in pregnancy is the lack of knowledge of their effects on the product. Gathering information on this regard becomes crucial so we can avoid relapses or exacerbation

Objectives

Describe neurodevelopmental effects in children ≥ 6 months exposed to antipsychotics prenatally.

Methods

PROSPERO-CRD42020170314. Using MeSH terms in 5 databases, without language and time restriction, obtaining n=3932. After review and exclusion n=24 were obtained for qualitative review. (Figure 1).

Results

Of 20 case reports 4 had more ambivalence results (Table 1). In the cohort studies, exposure may cause short-term delay at 6 months but no significant difference at 12 months (Table 2).Table 2

Study	N	Antipsychotic	Months	Conclusion using clinical evaluation
Imaz et al. Front. Pharmacol.2018; 9:264	1	RisperdalClozapine	72	Abnormal memory, attention/executive, hyperactivity
	1	Clozapine	32	Normal
	2	Clozapine	18	Abnormal
				Normal
Burt et al. Am J Psychiatry 2010; 167:892-897	1	Olanzapine	12,18,22,29	18 months Abnormal motor 22 months normal 29 months normal
Kirchheiner et al. Pharmacopsych 2000; 33:78-80	1	Olanzapine	7,11	7 months Abnormal motor11 months Normal
Mendhekar et al. J Neuropsychiatry Clin Neurosci 2007; 19:2	1	Clozapine	6	5 years Abnormal language

Table 3

Study	N	Antipsychotic	Months	Conclusion using clinimetry and clinical evaluation
Shao et al. Plos ONE, 2015; 10(4),1-9	63	ClozapineRisperidoneOlanzapineQuetiapine	6,12	BSID-III 6 months Adaptive behavior score lower in clozapine group 12 months No difference
Johnson et al. Arch Gen Psychiatry2012; 69(8), 787-794	22	HaloperidolSGA*	6	INFANIB Lower scores with SGA then Haloperidol
Peng et al. Psychopharmacology 2013; 228(4), 577-584	76	ClozapineRisperidoneSulpirideOlanzapineQuetiapine	6,12	BSID-III 6 months Lower socio-emotional and adaptive behavior scores12 months No difference
Petersen et al. BMJ 2016; 5(6), 1-9	290	FGA+SGA**	6	More neurodevelopmental disorder that those who didn’t take antipsychotics.

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Conclusions

Most are case reports, hence the importance of collecting this information, not ignoring it due to lack of methodological rigor. The intent is not to conclude that prenatal exposure to antipsychotics doesn’t have long-term neurodevelopmental effects, rather documenting the available evidence contributing to an informed clinical decision.

Disclosure of Interest

None Declared