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7 results

  • Risk of congenital malformations associated with first-trimester exposure to antipsychotics: A propensity score-weighted population-based cohort study

  • Joe K.N. Chan, Krystal C.K. Lee, Corine S.M. Wong, Wing C. Chang
  • Journal:
    European Psychiatry / Volume 67 / Issue 1 / 2024
    Published online by Cambridge University Press:
    27 May 2024, e42
    • Article
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  • Background

    There is growing concern regarding teratogenic effect of antipsychotics. Previous research assessing association between antipsychotics and congenital malformations (CMs) yielded mixed results and were all derived from Western countries. We aimed to examine risk of major and organ/system-specific CMs associated with prenatal antipsychotic exposure in Hong Kong.

    Methods

    This population-based study identified women aged 15–50 years who delivered their first/singleton child between 2003–2018 from public healthcare service database. Propensity score (PS)-weighted logistic-regression analyses were performed to examine risk of CMs following first-trimester exposure to antipsychotic classes (second- and first-generation antipsychotic; SGA and FGA) and six most frequently-prescribed individual antipsychotics.

    Results

    Of 465,069 women, 419 and 420 redeemed ≥1 prescription of SGA and FGA during first-trimester, respectively. Prevalence of any CMs was 4.9% (95%CI:4.9–5.0%) in unexposed-infants, 9.1% (6.7–12.3%) in SGA-exposed infants, and 6.2% (4.3–9.0%) in FGA-exposed infants. SGA exposure (adjusted-odds-ratio: 2.11 [95%CI:1.19–3.86]) was associated with increased risk of CMs. This finding was consistent with sensitivity analyses addressing exposure misclassification and confounding by treatment indication, but not with PS-matched sensitivity analysis. Elevated risk of CMs was observed in infants exposed to high-dose olanzapine (7.50 [1.65–36.13]) and high-dose quetiapine (15.03 [4.86–56.72]), but with wide-CIs. Organ/system-specific malformations were not associated with SGA, FGA or individual antipsychotics.

    Conclusion

    We observed a small increased risk of major malformations associated with SGA, but was not consistently affirmed in sensitivity analyses, precluding firm conclusions. Research with large sample size clarifying comparative safety of individual antipsychotics on specific malformations is warranted.

  • Chapter 13 - Perinatal Psychiatry

  • Edited by David Kingdon, University of Southampton, Paul Rowlands, Derbyshire Healthcare NHS foundation Trust, George Stein, Emeritus of the Princess Royal University Hospital
  • Book:
    Seminars in General Adult Psychiatry
    Published online:
    04 April 2024
    Print publication:
    18 April 2024, pp 598-635

  • Summary

    In this chapter, we review how pregnancy and the postnatal period influence the manifestations of psychiatric disorder. Although rare, the postpartum psychoses can be devastating illnesses, occasionally associated with suicide and require timely treatments to bring them under control. Postnatal depression by contrast is a common and readily diagnosed disorder and responds well to standard treatments such as CBT and medication. However, it may have complex effects on mothering and the new-born in the early months following childbirth, and the present-day perinatal services that manage the bulk of these cases are reviewed here. Any psychiatric disorder can appear during pregnancy, and some conditions may worsen, but a few may paradoxically improve. The prescribing of medication to this population is a complicated task because of teratogenic risks – some known, others imagined – as well their safety in breast feeding, which is also reviewed. Effects on infants and children are important, so the chapter ends with a review of child abuse and neglect and its current diagnosis and management.

  • Sodium valproate in psychiatric practice: time for a change in perception

  • David Cunningham Owens
  • Journal:
    The British Journal of Psychiatry / Volume 215 / Issue 3 / September 2019
    Published online by Cambridge University Press:
    13 June 2019, pp. 516-518
    Print publication:
    September 2019
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  • Sodium valproate and related preparations have recently undergone regulatory review following concern about effects on the unborn child and doctors' failure to communicate risk. The issues are wider. Valproate is overused in psychiatry based on the false perception that ‘ease’ of use equates to better safety than alternatives. Valproic acid can disrupt fundamental physiological processes, the consequences of which are poorly understood and little discussed in the psychiatric literature. Valproate may be useful in a small number of patients with bipolar disorder but current prescribing patterns are unjustified. Perception needs to change.

    Declaration of interest

    D.C.O. is psychiatric commissioner on the Commission on Human Medicines and a member of the European Medicines Agency's Scientific Advisory Group on Psychiatry. He chaired the European Medicines Agency's review of the psychiatric use of valproate in pregnancy and women of childbearing potential.

  • Congenital malformations caused by psychotropic drugs in pregnancy

  • G. de Cuypere, Ph. Rombaut, M. van Moffaert
  • Journal:
    Acta Neuropsychiatrica / Volume 4 / Issue 4 / December 1992
    Published online by Cambridge University Press:
    18 September 2015, pp. 77-85

  • After a description of the harmful effects of psychotropic drugs as well as of the moments of vulnerability to any teratogenic effect, this paper reviews prospective, retrospective and epidemiological studies of the teratogenic effects of anticonvulsants (phenytoin, valproic acid, carbamazepine and barbiturates), lithium, anti-psychotics, benzodiazepines and anti-depressive agents. It is found that the results of these studies are not unequivocal. Only lithium and valproic acid are shown to be teratogenic. In cases where malformations of the fetus are observed, the treatment often consisted in a combination of various psychotropic drugs.

    The review is completed with data on the psychopharmacological problems during delivery and their side-effects on the newborn.

  • Chapter 10 - Ambulatory and patient-controlled epidural analgesia

  • Edited by Ian McConachie, University of Western Ontario
  • Book:
    Controversies in Obstetric Anesthesia and Analgesia
    Published online:
    05 December 2011
    Print publication:
    17 November 2011, pp 131-139

  • Summary

    Over the last decade there has been an explosion of literature published on the neuroapoptosis induced by anesthetic drugs in animals and the potential impact this may have on fetuses, neonates, and infants. The period of brain growth when synaptic differentiation occurs, also called synaptogenesis, occurs from the sixth month of gestation to 24 months after birth in humans. The teratogenicity of a substance is multifactorial and includes species susceptibility, dose, duration and timing of exposure, and genetic predisposition. Anesthetics have been shown to cause apoptosis in numerous cell types as well as cause neurotoxicity in a concentration- and time-dependent manner in in-vitro and in-vivo models, and mechanisms have been proposed based on the receptor activity of the anesthetic agents. In an extensive review on the effects of general anesthetics on developing brain structure and neurocognitive function, the evidence for individual anesthetic agents causing neurodegeneration and functional impairment was discussed.