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Long–term Neurodevelopment outcomes to Prenatal Antipsychotic Medication Exposure: Systemic Review
Published online by Cambridge University Press: 19 July 2023
Abstract
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Introduction
Peak incidence for many psychiatric disorders occurs in reproductive years. We don’t have FDA-approved drugs or clinical guidelines. The main cause of pharmacological suspension in pregnancy is the lack of knowledge of their effects on the product. Gathering information on this regard becomes crucial so we can avoid relapses or exacerbation
Objectives
Describe neurodevelopmental effects in children ≥ 6 months exposed to antipsychotics prenatally.
Methods
PROSPERO-CRD42020170314. Using MeSH terms in 5 databases, without language and time restriction, obtaining n=3932. After review and exclusion n=24 were obtained for qualitative review. (Figure 1).
Results
Table 3
Of 20 case reports 4 had more ambivalence results (Table 1). In the cohort studies, exposure may cause short-term delay at 6 months but no significant difference at 12 months (Table 2).Table 2
| Study | N | Antipsychotic | Months | Conclusion using clinical evaluation |
|---|---|---|---|---|
| Imaz et al. Front. Pharmacol.2018; 9:264 | 1 | RisperdalClozapine | 72 | Abnormal memory, attention/executive, hyperactivity |
| 1 | Clozapine | 32 | Normal | |
| 2 | Clozapine | 18 | Abnormal | |
| Normal | ||||
| Burt et al. Am J Psychiatry 2010; 167:892-897 | 1 | Olanzapine | 12,18,22,29 | 18 months Abnormal motor 22 months normal 29 months normal |
| Kirchheiner et al. Pharmacopsych 2000; 33:78-80 | 1 | Olanzapine | 7,11 | 7 months Abnormal motor11 months Normal |
| Mendhekar et al. J Neuropsychiatry Clin Neurosci 2007; 19:2 | 1 | Clozapine | 6 | 5 years Abnormal language |
| Study | N | Antipsychotic | Months | Conclusion using clinimetry and clinical evaluation |
|---|---|---|---|---|
| Shao et al. Plos ONE, 2015; 10(4),1-9 | 63 | ClozapineRisperidoneOlanzapineQuetiapine | 6,12 | BSID-III 6 months Adaptive behavior score lower in clozapine group 12 months No difference |
| Johnson et al. Arch Gen Psychiatry2012; 69(8), 787-794 | 22 | HaloperidolSGA* | 6 | INFANIB Lower scores with SGA then Haloperidol |
| Peng et al. Psychopharmacology 2013; 228(4), 577-584 | 76 | ClozapineRisperidoneSulpirideOlanzapineQuetiapine | 6,12 | BSID-III 6 months Lower socio-emotional and adaptive behavior scores12 months No difference |
| Petersen et al. BMJ 2016; 5(6), 1-9 | 290 | FGA+SGA** | 6 | More neurodevelopmental disorder that those who didn’t take antipsychotics. |
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Conclusions
Most are case reports, hence the importance of collecting this information, not ignoring it due to lack of methodological rigor. The intent is not to conclude that prenatal exposure to antipsychotics doesn’t have long-term neurodevelopmental effects, rather documenting the available evidence contributing to an informed clinical decision.
Disclosure of Interest
None Declared
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- European Psychiatry , Volume 66 , Special Issue S1: Abstracts of the 31st European Congress of Psychiatry , March 2023 , pp. S503 - S504
- Creative Commons
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.- Copyright
- © The Author(s), 2023. Published by Cambridge University Press on behalf of the European Psychiatric Association
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