Title:Is Antipsychotic Drug Use During Pregnancy Associated with Increased Malformation Rates and Worsening of Maternal and Infant Outcomes? A Systematic Review
Volume: 22
Issue: 14
Author(s): Gabriele Sani, Tommaso Callovini, Ottavia Marianna Ferrara, Daniele Segatori, Stella Margoni, Alessio Simonetti, Francesco Maria Lisci, Giuseppe Marano, Alessia Fischetti, Georgios D. Kotzalidis*, Federica Di Segni, Federica Fiaschè, Delfina Janiri, Lorenzo Moccia, Giovanni Manfredi, Alessandro Alcibiade, Caterina Brisi, Flavia Grisoni, Gianmarco Stella, Evelina Bernardi, Andrea Brugnami, Michele Ciliberto, Maria Chiara Spera, Romina Caso, Sara Rossi, Gianluca Boggio, Giulia Mastroeni, Francesca Abate, Eliana Conte, Anna Quintano, Lavinia De Chiara, Laura Monti, Giovanni Camardese, Lucio Rinaldi, Alexia E. Koukopoulos, Daniela Pia Rosaria Chieffo, Gloria Angeletti and Marianna Mazza
Affiliation:
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8,
00168 Rome, Italy
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Sant'Andrea Hospital, Via di
Grottarossa 1035-1039, 00189 Rome, Italy
Keywords:
Pregnancy, malformations, major, teratogenicity, lactation, antipsychotic drugs, second generation antipsychotics.
Abstract: There is much debate about continuing antipsychotic medication in patients who need it when
they become pregnant because benefits must be weighed against potential teratogenic and malformation
effects related to antipsychotics themselves. To address this, we conducted a systematic review on the
PubMed, PsycINFO and CINHAL databases and the ClinicalTrials.gov register using the following strategy:
(toxicity OR teratogenicity OR malformation* OR "birth defect*" OR "congenital abnormality" OR
"congenital abnormalities" OR "brain changes" OR "behavioral abnormalities" OR "behavioral abnormalities")
AND antipsychotic* AND (pregnancy OR pregnant OR lactation OR delivery OR prenatal OR
perinatal OR post-natal OR puerperium) on September 27, 2023. We found 38 studies to be eligible. The
oldest was published in 1976, while most articles were recent. Most studies concluded that the antipsychotics,
especially the second-generation antipsychotics, were devoid of teratogenic potential, while few
studies were inconclusive and recommended replication. Most authoritative articles were from the Boston
area, where large databases were implemented to study the malformation potential of psychiatric drugs.
Other reliable databases are from Northern European registers. Overall conclusions are that antipsychotics
are no more related to malformations than the disorders themselves; most studies recommend that
there are no reasons to discontinue antipsychotic medications in pregnancy.
