Antipsychotic medication during pregnancy does affect babies, study shows
A seven-year study of women who take antipsychotic medication while pregnant, proves it can affect babies.
The observational study, published in the journal PLOS ONE, reveals that whilst most women gave birth to healthy babies, the use of mood stabilisers or higher doses of antipsychotics during pregnancy increased the need for special care after birth with 43 per cent of babies placed in a Special Care Nursery (SCN) or a Neonatal Intensive Care Unit (NICU), almost three times the national rate in Australia.
As well as an increased likelihood of the need for intensive care, the world-first study by experts from the Monash Alfred Psychiatry Research Centre (MAPrc) and Monash University, shows antipsychotic drugs affects babies in other ways; 18 per cent were born prematurely, 37 per cent showed signs of respiratory distress and 15 per cent developed withdrawal symptoms.
Principal investigator, Professor Jayashri Kulkarni, Director of MAPrc, said the study highlights the need for clearer health guidelines when antipsychotic drugs are taken during pregnancy.
"There's been little research on antipsychotic medication during pregnancy and if it affects babies. The lack of data has made it very difficult for clinicians to say anything conclusively on how safe it is for babies," Professor Kulkarni said.
"This new research confirms that most babies are born healthy, but many experience neonatal problems such as respiratory distress."
With no existing data to draw on, MAPrc established the world-first National Register of Antipsychotic Medications in Pregnancy (NRAMP) in 2005. Women who were pregnant and taking antipsychotic medication were recruited from around Australia through clinical networks in each state and territory. In all 147 women were interviewed every six weeks during pregnancy and then followed until their babies were one year old.
Antipsychotic drugs are currently used to treat a range of psychiatric disorders including schizophrenia, major depression and bipolar disorder. About 20 per cent of Australian women experience depression in their lifetime, compared to 10 per cent of men. In Australia 25 per cent of women experience postnatal depression and 20 per cent experience severe menopausal depression.
Women have much higher rates of anxiety disorders and there are equal percentages of men and women with schizophrenia (2 per cent) and bipolar disorder (about 3 per cent).
Professor Kulkarni said the emergence of new antipsychotic drugs means that many women with a well controlled psychiatric disorder are able to contemplate having babies, but there have always been concerns about the effect of treatment on their offspring.
"The potentially harmful effects of taking an antipsychotic drug in pregnancy have to be balanced against the harm of untreated psychotic illness. The good news is we now know there are no clear associations with specific congenital abnormalities and these drugs," Professor Kulkarni said.
"However clinicians should be particularly mindful of neonatal problems such as respiratory distress, so it's critical that Neonatal Intensive Care Units, or Special Care Nurseries are available for these babies."
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Jayashri Kulkarni, Roisin Worsley, Heather Gilbert, Emorfia Gavrilidis, Tamsyn E. Van Rheenen, Wei Wang, Kay McCauley, Paul Fitzgerald. A Prospective Cohort Study of Antipsychotic Medications in Pregnancy: The First 147 Pregnancies and 100 One Year Old Babies. PLoS ONE, Published May 2 2014. doi: 10.1371/journal.pone.0094788