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Erschienen in: Current Psychiatry Reports 1/2016

01.01.2016 | Complex Medical-Psychiatric Issues (MB Riba, Section Editor)

Managing Your Own Mood Lability: Use of Mood Stabilizers and Antipsychotics in Pregnancy

verfasst von: Christina L. Wichman

Erschienen in: Current Psychiatry Reports | Ausgabe 1/2016

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Abstract

The management of psychiatric disorders during the perinatal period can be difficult; psychiatric decompensation during pregnancy can affect not only the mother but also the fetus and neonate. It is imperative that psychiatric providers proactively discuss pregnancy planning, and be able to thoughtfully weigh the risks of untreated psychiatric illness and psychotropic medications in pregnancy and breast-feeding. With the exception of valproate and carbamazepine, several mood stabilizers and antipsychotics can be utilized during pregnancy with minimal risk to the fetus and neonate in terms of major malformations; there is a growing body of evidence regarding the risk profile of use of these medications in pregnancy.
Key Points
  • Preconception planning is very helpful when it can be done; consider discussion and documentation of risks at time of administration of psychotropic medications for any reproductive-aged women, regardless of plans for conception.
  • Continued psychiatric stability through the perinatal period is imperative; the risks of an untreated psychiatric disorder are just as important, if not more so important, than the risks of psychotropic medication exposure.
  • Exposure to one psychotropic medication is safer than exposure to multiple medications.
  • Utilize lowest effective dose of medication; most risks are not dose dependent, therefore would typically prefer higher dose of medication, rather than emergence of psychiatric symptoms, in order to avoid exposure of the fetus to both psychotropic medications and psychiatric symptoms.
  • General recommendations are to avoid valproate and carbamazepine in reproductive-aged women.
  • With close monitoring, lithium can be safely utilized in pregnancy.
  • Preliminary data regarding use of atypical antipsychotics is reassuring in regards to major malformations; however, larger numbers of participants are needed to provide more complete reproductive safety data with this class.
  • Clearly document risks of an untreated psychiatric illness as well as risks of psychotropic medication management to the mother and developing fetus/neonate.
Literatur
2.
Zurück zum Zitat Robinson G. Controversies about the use of antidepressants in pregnancy. J Nerv Ment Dis. 2015;203:159–63.CrossRefPubMed Robinson G. Controversies about the use of antidepressants in pregnancy. J Nerv Ment Dis. 2015;203:159–63.CrossRefPubMed
3.
Zurück zum Zitat Viguera AC, Nonacs R, Cohen LS, et al. Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. Am J Psychiatry. 2000;157:179–84.CrossRefPubMed Viguera AC, Nonacs R, Cohen LS, et al. Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. Am J Psychiatry. 2000;157:179–84.CrossRefPubMed
4.
Zurück zum Zitat Viguera AC, Whitfield T, Baldessarini RJ, et al. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatry. 2007;164:1817–24.CrossRefPubMed Viguera AC, Whitfield T, Baldessarini RJ, et al. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatry. 2007;164:1817–24.CrossRefPubMed
5.
Zurück zum Zitat Vigod SN, Kurdyak PA, Demia CL, Gruneir A, et al. Maternal and newborn outcomes among women with schizophrenia: a retrospective population-based newborn study. BJOG. 2014;121(5):566–74.CrossRefPubMed Vigod SN, Kurdyak PA, Demia CL, Gruneir A, et al. Maternal and newborn outcomes among women with schizophrenia: a retrospective population-based newborn study. BJOG. 2014;121(5):566–74.CrossRefPubMed
6.
Zurück zum Zitat Cohen LS, Friedman JM, Jefferson JW, et al. A reevaluation of risk of in utero exposure to lithium. JAMA. 1994;271:146–50.CrossRefPubMed Cohen LS, Friedman JM, Jefferson JW, et al. A reevaluation of risk of in utero exposure to lithium. JAMA. 1994;271:146–50.CrossRefPubMed
7.
Zurück zum Zitat van der Lugt NM, van de Maat JS, van Kamp IL, et al. Fetal, neonatal and developmental outcomes of lithium-exposed pregnancies. Early Hum Dev. 2012;88(6):375–8.CrossRefPubMed van der Lugt NM, van de Maat JS, van Kamp IL, et al. Fetal, neonatal and developmental outcomes of lithium-exposed pregnancies. Early Hum Dev. 2012;88(6):375–8.CrossRefPubMed
8.
9.
Zurück zum Zitat Ornoy A. Valproic acid in pregnancy: how much are we endangering the embryo and fetus? Reprod Toxicol. 2009;28(1):1–10.CrossRefPubMed Ornoy A. Valproic acid in pregnancy: how much are we endangering the embryo and fetus? Reprod Toxicol. 2009;28(1):1–10.CrossRefPubMed
10.
Zurück zum Zitat Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, et al. NEAD Study Group. Effects of fetal antiepileptic drug exposure: Outcomes at age 4.5 years. Neurology. 2012;78(16):1207–14.PubMedCentralCrossRefPubMed Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, et al. NEAD Study Group. Effects of fetal antiepileptic drug exposure: Outcomes at age 4.5 years. Neurology. 2012;78(16):1207–14.PubMedCentralCrossRefPubMed
11.
Zurück zum Zitat Christensen J, Grønborg TK, Sørensen MJ, Schendel D, Parner ET, Pedersen LH, et al. Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. JAMA. 2013;309(16):1696–703.PubMedCentralCrossRefPubMed Christensen J, Grønborg TK, Sørensen MJ, Schendel D, Parner ET, Pedersen LH, et al. Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. JAMA. 2013;309(16):1696–703.PubMedCentralCrossRefPubMed
12.
Zurück zum Zitat Rosa FW. Spina bifida in infants of women treated with carbamazepine during pregnancy. NEJM. 1991;324:674–7.CrossRefPubMed Rosa FW. Spina bifida in infants of women treated with carbamazepine during pregnancy. NEJM. 1991;324:674–7.CrossRefPubMed
13.
Zurück zum Zitat Cummings C, Stewart M, Stevenson M, Morrow J, Nelson J. Neurodevelopment of children exposed in utero to lamotrigine, sodium valproate and carbamazepine. Arch Dis Child. 2011;96:643–7.CrossRefPubMed Cummings C, Stewart M, Stevenson M, Morrow J, Nelson J. Neurodevelopment of children exposed in utero to lamotrigine, sodium valproate and carbamazepine. Arch Dis Child. 2011;96:643–7.CrossRefPubMed
14.
Zurück zum Zitat Hernández-Díaz S, Smith CR, Shen A, Mittendorf R, Hauser WA, Yerby M, et al. Comparative safety of antiepileptic drugs during pregnancy. Neurology. 2012;78:1692–9.CrossRefPubMed Hernández-Díaz S, Smith CR, Shen A, Mittendorf R, Hauser WA, Yerby M, et al. Comparative safety of antiepileptic drugs during pregnancy. Neurology. 2012;78:1692–9.CrossRefPubMed
15.
Zurück zum Zitat Holmes LB, Baldwin EJ, Smith CR, Habecker E, Glassman L, Wong SL, et al. Increased frequency of isolated cleft palate in infants exposed to lamotrigine during pregnancy. Neurology. 2008;70(22 Pt 2):2152–8.CrossRefPubMed Holmes LB, Baldwin EJ, Smith CR, Habecker E, Glassman L, Wong SL, et al. Increased frequency of isolated cleft palate in infants exposed to lamotrigine during pregnancy. Neurology. 2008;70(22 Pt 2):2152–8.CrossRefPubMed
16.
Zurück zum Zitat Dolk H, Jentink J, Loane M, Morris J, de Jong-van den Berg LT. EUROCAT Antiepileptic Drug Working Group. Does lamotrigine use in pregnancy increase orofacial cleft risk relative to other malformations? Neurology. 2008;71(10):714–22.CrossRefPubMed Dolk H, Jentink J, Loane M, Morris J, de Jong-van den Berg LT. EUROCAT Antiepileptic Drug Working Group. Does lamotrigine use in pregnancy increase orofacial cleft risk relative to other malformations? Neurology. 2008;71(10):714–22.CrossRefPubMed
17.
Zurück zum Zitat Fujii H, Goel A, Bernard N, et al. Pregnancy outcomes following gabapentin use: results of a prospective comparative cohort study. Neurology. 2013;80(17):1565–70.PubMedCentralCrossRefPubMed Fujii H, Goel A, Bernard N, et al. Pregnancy outcomes following gabapentin use: results of a prospective comparative cohort study. Neurology. 2013;80(17):1565–70.PubMedCentralCrossRefPubMed
18.
Zurück zum Zitat Alsaad AM, Chaudhry SA, Koren G. First trimester exposure to topiramate and the risk of oral clefts in the offspring: A systematic review and meta-analysis. Reprod Toxicol. 2015;53:45–50.CrossRefPubMed Alsaad AM, Chaudhry SA, Koren G. First trimester exposure to topiramate and the risk of oral clefts in the offspring: A systematic review and meta-analysis. Reprod Toxicol. 2015;53:45–50.CrossRefPubMed
19.
Zurück zum Zitat Tennis P, Chan KA, Curkendall SM, et al. Topiramate use during pregnancy and major congenital malformations in multiple populations. Birth Defects Res A Clin Mol Teratol. 2015;103(4):269–75.CrossRefPubMed Tennis P, Chan KA, Curkendall SM, et al. Topiramate use during pregnancy and major congenital malformations in multiple populations. Birth Defects Res A Clin Mol Teratol. 2015;103(4):269–75.CrossRefPubMed
20.
Zurück zum Zitat McKenna K, Koren G, Tetelbaum M, Wilton L, Shakir S, Diav-Citrin O, et al. Pregnancy outcome of women using atypical antipsychotic drugs: a prospective comparative study. J Clin Psychiatry. 2005;66(4):444–9.CrossRefPubMed McKenna K, Koren G, Tetelbaum M, Wilton L, Shakir S, Diav-Citrin O, et al. Pregnancy outcome of women using atypical antipsychotic drugs: a prospective comparative study. J Clin Psychiatry. 2005;66(4):444–9.CrossRefPubMed
21.
Zurück zum Zitat Cohen LS, Viguera AC, McInerney K, et al. The National Pregnancy Registry for Atypical Antipsychotics: Effects of Fetal Exposure on Risk for Major Malformations. Presented at the Annual Meeting of the American Society of Clinical Psychopharmacology, June 2014 Cohen LS, Viguera AC, McInerney K, et al. The National Pregnancy Registry for Atypical Antipsychotics: Effects of Fetal Exposure on Risk for Major Malformations. Presented at the Annual Meeting of the American Society of Clinical Psychopharmacology, June 2014
22.
Zurück zum Zitat Kulkarni J, Worsley R, Gilbert H, Gavrilidis E, Van Rheenen TE, Wang W, et al. A prospective cohort study of antipsychotic medications in pregnancy: the first 147 pregnancies and 100 one year old Babies. PLoS One. 2014;9(5):e94788.PubMedCentralCrossRefPubMed Kulkarni J, Worsley R, Gilbert H, Gavrilidis E, Van Rheenen TE, Wang W, et al. A prospective cohort study of antipsychotic medications in pregnancy: the first 147 pregnancies and 100 one year old Babies. PLoS One. 2014;9(5):e94788.PubMedCentralCrossRefPubMed
23.•
Zurück zum Zitat Vigod SN, Gomes T, Wilton AS, et al. Antipsychotic drug use in pregnancy: high dimensional, propensity matched, population based cohort study. BMJ. 2015;350:h2298. Cohort study of antipsychotic use in pregnancy which did not demonstrate an increased risk of maternal obstetrical outcomes.PubMedCentralCrossRefPubMed Vigod SN, Gomes T, Wilton AS, et al. Antipsychotic drug use in pregnancy: high dimensional, propensity matched, population based cohort study. BMJ. 2015;350:h2298. Cohort study of antipsychotic use in pregnancy which did not demonstrate an increased risk of maternal obstetrical outcomes.PubMedCentralCrossRefPubMed
24.•
Zurück zum Zitat Coughlin CG, Blackwell KA, Bartley C, Hay M, Yonkers KA, Bloch MH. Obstetric and neonatal outcomes after antipsychotic medication exposure in pregnancy. Obstet Gynecol. 2015;125(5):1224–35. Meta-analysis reviewing typical and atypical antipsychotics; no demonstrated difference in the risks of major malformations between these two groups; antipsychotic exposure was not associated with other poor obstetrical outcomes.CrossRefPubMed Coughlin CG, Blackwell KA, Bartley C, Hay M, Yonkers KA, Bloch MH. Obstetric and neonatal outcomes after antipsychotic medication exposure in pregnancy. Obstet Gynecol. 2015;125(5):1224–35. Meta-analysis reviewing typical and atypical antipsychotics; no demonstrated difference in the risks of major malformations between these two groups; antipsychotic exposure was not associated with other poor obstetrical outcomes.CrossRefPubMed
25.
Zurück zum Zitat Boden R et al. Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: Population based cohort study. BMJ. 2012;345:e7085.PubMedCentralCrossRefPubMed Boden R et al. Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: Population based cohort study. BMJ. 2012;345:e7085.PubMedCentralCrossRefPubMed
Metadaten
Titel
Managing Your Own Mood Lability: Use of Mood Stabilizers and Antipsychotics in Pregnancy
verfasst von
Christina L. Wichman
Publikationsdatum
01.01.2016
Verlag
Springer US
Erschienen in
Current Psychiatry Reports / Ausgabe 1/2016
Print ISSN: 1523-3812
Elektronische ISSN: 1535-1645
DOI
https://doi.org/10.1007/s11920-015-0646-1

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