Use of psychotropic drugs during pregnancy: necessity vs Safety
Use of psychotropic drugs during pregnancy: Necessity vs Safety
DOI:
https://doi.org/10.22517/25395203.25400Keywords:
psychotropic drugs, Pregnant Women, antidepressants agents, Antipsychotic Agents, Antimanic AgentsAbstract
The safety of psychoactive drugs during pregnancy is a crucial issue in clinical practice. In this review, a brief overview of the changes in pregnancy that impact the pharmacodynamics of drugs is made; in addition, the main pharmacological groups in psychiatry and their effects during pregnancy are analyzed.
Three critical periods during pregnancy are identified. The period of the first two weeks is associated with an increased risk of miscarriage. The period from the second to the tenth week is the most at risk , since teratogenic effects that affect fetal development can take place. The period after the tenth week is characterized by alterations in fetal growth and functional development , however ,less severe defects.
Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), and second-generation antipsychotics are considered the safest, but the latter may be associated with metabolic syndrome, congenital heart disease, and neurodevelopmental disorders. Lithium has been associated with teratogenic effects and cardiac malformations, while valproate is associated with major birth defects. Benzodiazepines can have toxic effects and cause Neonatal Withdrawal Syndrome .
The safety of psychotropic drugs during pregnancy requires an individualized assesment of the benefits and risks. Although some groups of psychiatric drugs are considered relatively safe, caution is needed when considering the potential complications associated with their use during pregnancy.
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References
Chaudron LH. Complex challenges in treating depression during pregnancy. Am J Psychiatry. enero de 2013;170(1):12-20.
Ban L, Gibson JE, West J, Fiaschi L, Sokal R, Smeeth L, et al. Maternal depression, antidepressant prescriptions, and congenital anomaly risk in offspring: a population-based cohort study. BJOG. noviembre de 2014;121(12):1471-81.
Ornoy A, Weinstein-Fudim L, Ergaz Z. Antidepressants, Antipsychotics, and Mood Stabilizers in Pregnancy: What Do We Know and How Should We Treat Pregnant Women with Depression. Birth Defects Res. 17 de julio de 2017;109(12):933-56.
Camuñas Palacín A, Grigg J, Gilbert H, Worsley R, Gavrilidis E, Kulkarni J. Seguridad de los antipsicóticos atípicos en el embarazo. Psiquiatría Biológica. 1 de enero de 2016;23(1):23-8.
Orueta Sánchez, R, López Gil, M.J, Manejo de fármacos durante el embarazo Médico de Familia. Centro de Salud “Sillería”. Inf Ter Sist Nac Salud 2011; 35 (1): 107-113.
Schoretsanitis G, Westin AA, Stingl JC, Deligiannidis KM, Paulzen M, Spigset O. Antidepressant transfer into amniotic fluid, umbilical cord blood & breast milk: A systematic review & combined analysis. Prog Neuropsychopharmacol Biol Psychiatry. 20 de abril de 2021;107:110228.
Bérard A, Zhao JP, Sheehy O. Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort. BMJ Open. 12 de enero de 2017;7(1):e013372.
Gentile S. Tricyclic antidepressants in pregnancy and puerperium. Expert Opin Drug Saf. febrero de 2014;13(2):207-25.
Palmsten K, Setoguchi S, Margulis AV, Patrick AR, Hernández-Díaz S. Elevated risk of preeclampsia in pregnant women with depression: depression or antidepressants? Am J Epidemiol. 15 de mayo de 2012;175(10):988-97.
Palmsten K, Hernández-Díaz S, Huybrechts KF, Williams PL, Michels KB, Achtyes ED, et al. Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States. BMJ. 21 de agosto de 2013;347:f4877.
Jordan S, Morris JK, Davies GI, Tucker D, Thayer DS, Luteijn JM, et al. Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressants in Pregnancy and Congenital Anomalies: Analysis of Linked Databases in Wales, Norway and Funen, Denmark. PLoS One. 2016;11(12):e0165122.
Olivier JDA, Akerud H, Kaihola H, Pawluski JL, Skalkidou A, Högberg U, et al. The effects of maternal depression and maternal selective serotonin reuptake inhibitor exposure on offspring. Front Cell Neurosci. 2013;7:73. 1.
Malm H, Artama M, Gissler M, Ritvanen A. Selective serotonin reuptake inhibitors and risk for major congenital anomalies. Obstet Gynecol. julio de 2011;118(1):111-20.
Louik C, Lin AE, Werler MM, Hernández-Díaz S, Mitchell AA. First-trimester use of selective serotonin-reuptake inhibitors and the risk of birth defects. N Engl J Med. 28 de junio de 2007;356(26):2675-83.
Almeida ND, Basso O, Abrahamowicz M, Gagnon R, Tamblyn R. Risk of Miscarriage in Women Receiving Antidepressants in Early Pregnancy, Correcting for Induced Abortions. Epidemiology. julio de 2016;27(4):538-46.
Yonkers KA, Gilstad-Hayden K, Forray A, Lipkind HS. Association of Panic Disorder, Generalized Anxiety Disorder, and Benzodiazepine Treatment During Pregnancy With Risk of Adverse Birth Outcomes. JAMA Psychiatry. 1 de noviembre de 2017;74(11):1145-52.
Bruning AHL, Heller HM, Kieviet N, Bakker PCAM, de Groot CJM, Dolman KM, et al. Antidepressants during pregnancy and postpartum hemorrhage: a systematic review. Eur J Obstet Gynecol Reprod Biol. junio de 2015;189:38-47.
McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, et al. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol. mayo de 2017;31(5):519-52.
Wang XY, Ying XH, Jiang HY. Antidepressant use during pregnancy and the risk for gestational diabetes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. diciembre de 2023;36(1):2162817.
Ramsteijn AS, Van de Wijer L, Rando J, van Luijk J, Homberg JR, Olivier JDA. Perinatal selective serotonin reuptake inhibitor exposure and behavioral outcomes: A systematic review and meta-analyses of animal studies. Neurosci Biobehav Rev. julio de 2020;114:53-69
Bayrampour H, Kapoor A, Bunka M, Ryan D. The Risk of Relapse of Depression During Pregnancy After Discontinuation of Antidepressants: A Systematic Review and Meta-Analysis. J Clin Psychiatry. 9 de junio de 2020;81(4):19r13134
Huybrechts KF, Bateman BT, Pawar A, Bessette LG, Mogun H, Levin R, et al. Maternal and fetal outcomes following exposure to duloxetine in pregnancy: cohort study. BMJ. 19 de febrero de 2020;368:m237.
Richardson JL, Martin F, Dunstan H, Greenall A, Stephens S, Yates LM, et al. Pregnancy outcomes following maternal venlafaxine use: A prospective observational comparative cohort study. Reprod Toxicol. marzo de 2019;84:108-13.
Uguz F. Is There Any Association Between Use of Antidepressants and Preeclampsia or Gestational Hypertension?: A Systematic Review of Current Studies. J Clin Psychopharmacol. febrero de 2017;37(1):72-7.
Bellantuono C, Vargas M, Mandarelli G, Nardi B, Martini MG. The safety of serotonin-noradrenaline reuptake inhibitors (SNRIs) in pregnancy and breastfeeding: a comprehensive review. Hum Psychopharmacol. mayo de 2015;30(3):143-51.
Kranzler HR, Washio Y, Zindel LR, Wileyto EP, Srinivas S, Hand DJ, et al. Placebo-controlled trial of bupropion for smoking cessation in pregnant women. Am J Obstet Gynecol MFM. noviembre de 2021;3(6):100315
Chun-Fai-Chan B, Koren G, Fayez I, Kalra S, Voyer-Lavigne S, Boshier A, et al. Pregnancy outcome of women exposed to bupropion during pregnancy: a prospective comparative study. Am J Obstet Gynecol. marzo de 2005;192(3):932-6.
Smit M, Dolman KM, Honig A. Mirtazapine in pregnancy and lactation - A systematic review. Eur Neuropsychopharmacol. enero de 2016;26(1):126-35.
Robiyanto R, Schuiling-Veninga CCM, Bos JHJ, Hak E, van Puijenbroek EP. Exposure to psychotropic drugs before and during pregnancy: what has changed over the last two decades? Arch Womens Ment Health. febrero de 2023;26(1):39-48.
Startpagina—Antipsychotica en niet-SSRI antidepressiva tijdens zwangerscha en lactatie—Richtlijn—Richtlijnendatabase. (s. f.). Recuperado 14 de mayo de 2023, de https://richtlijnendatabase.nl/richtlijn/antipsychotica_en_niet-ssri_antidepressiva_tijdens_zwangerschap_en_lactatie/startpagina_-_antipsychotica_en_niet-ssri_antidepressiva_tijdens_zwangerschap_en_lactatie.html
Heinonen E, Forsberg L, Nörby U, Wide K, Källén K. Antipsychotic Use During Pregnancy and Risk for Gestational Diabetes: A National Register-Based Cohort Study in Sweden. CNS Drugs. mayo de 2022;36(5):529-39.
Wang Z, Chan AYL, Coghill D, Ip P, Lau WCY, Simonoff E, et al. Association Between Prenatal Exposure to Antipsychotics and Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, Preterm Birth, and Small for Gestational Age. JAMA Internal Medicine. 1 de octubre de 2021;181(10):1332-40.
Hálfdánarson Ó, Cohen JM, Karlstad Ø, Cesta CE, Bjørk MH, Håberg SE, et al. Antipsychotic use in pregnancy and risk of attention/deficit-hyperactivity disorder and autism spectrum disorder: a Nordic cohort study. BMJ Ment Health. 1 de mayo de 2022;25(2):54-62.
Anderson KN, Ailes EC, Lind JN, Broussard CS, Bitsko RH, Friedman JM, et al. Atypical antipsychotic use during pregnancy and birth defect risk: National Birth Defects Prevention Study, 1997-2011. Schizophr Res. enero de 2020;215:81-8.
Reutfors J, Cesta CE, Cohen JM, Bateman BT, Brauer R, Einarsdóttir K, et al. Antipsychotic drug use in pregnancy: A multinational study from ten countries. Schizophr Res. junio de 2020;220:106-15.
Straub L, Hernández-Díaz S, Bateman BT, Wisner KL, Gray KJ, Pennell PB, et al. Association of Antipsychotic Drug Exposure in Pregnancy With Risk of Neurodevelopmental Disorders: A National Birth Cohort Study. JAMA Internal Medicine. 1 de mayo de 2022;182(5):522-33.
Newport DJ, Viguera AC, Beach AJ, Ritchie JC, Cohen LS, Stowe ZN. Lithium placental passage and obstetrical outcome: implications for clinical management during late pregnancy. Am J Psychiatry. noviembre de 2005;162(11):2162-70.
Patorno E, Huybrechts KF, Bateman BT, Cohen JM, Desai RJ, Mogun H, et al. Lithium Use in Pregnancy and the Risk of Cardiac Malformations. N Engl J Med. 8 de junio de 2017;376(23):2245-54.
Munk-Olsen T, Liu X, Viktorin A, Brown HK, Di Florio A, D’Onofrio BM, et al. Maternal and infant outcomes associated with lithium use in pregnancy: an international collaborative meta-analysis of six cohort studies. Lancet Psychiatry. agosto de 2018;5(8):644-52.
Hastie R, Tong S, Hiscock R, Lindquist A, Lindström L, Wikström AK, et al. Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study. BMC Med. 2 de diciembre de 2021;19(1):291.
Aykan DA, Ergün Y. Cross-sectional evaluation of prescription of valproate and other antiepileptic drugs to pregnant women. Acta Neurol Belg. abril de 2021;121(2):503-8.
Sharma AR, Batra G, Saini L, Sharma S, Mishra A, Singla R, et al. Valproic Acid and Propionic Acid Modulated Mechanical Pathways Associated with Autism Spectrum Disorder at Prenatal and Neonatal Exposure. CNS Neurol Disord Drug Targets. 2022;21(5):399-408.
Li Y, Meador KJ. Epilepsy and Pregnancy. Continuum (Minneap Minn). 1 de febrero de 2022;28(1):34-54.
Reis M, Källén B. Combined use of selective serotonin reuptake inhibitors and sedatives/hypnotics during pregnancy: risk of relatively severe congenital malformations or cardiac defects. A register study. BMJ Open. 2013;3(2):e002166.
Gentile S. Neurodevelopmental effects of prenatal exposure to psychotropic medications. Depress Anxiety. julio de 2010;27(7):675-86.
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