Psychopharmacologic Therapy in Pregnancy: Effects on Newborns
By Emilio J. Sanz, MD, PhD and Carlos De las Cuevas, MD, PhD |
May 1, 2006
Antiepileptic drugs (AEDs)
A mother's use of AEDs is linked to
the immediate withdrawal effects of the
newborn and to long-term neurologic
dysfunctions. Valproate(Drug information on valproate) was shown to
be associated with immediate NWS symptoms, such as hyperexcitability,
causing neurologic deficits, seizures,
and jitteriness.32,33 Furthermore, in a
retrospective study based on hospital
records, Dean and associates34 found
significant NWS symptoms, including
jitteriness, hypotonia, seizures, apneic
episodes, hypoglycemia, and feeding
disorder, after exposure in utero to
valproate, phenytoin(Drug information on phenytoin), or combination
Long-term effects of AEDs have
also been demonstrated. In the study by
Koch and associates,32 when children
were examined 6 years later, they
continued to have long-term neurologic
dysfunctions, which are more congruent
with drug toxicity than withdrawal
effects. Similar results are reported in
the study by Moore and associates33 of
57 children prenatally exposed to AEDs:
77% had learning difficulties, 81% had
speech delay, 60% had gross motor
delay, and 42% had fine motor delay.
Eighty percent of these children had
prenatal exposure to valproate alone or
in combination with another AED.
Seventy-four percent of school-aged
children were enrolled in special education
classes or were receiving learning
support, and 81% had some type of
behavioral dysfunction; of these, 60%
had some autistic features and 39% had
hyperactivity, but autism or Asperger
syndrome had actually been diagnosed
in only a few. The developmental effects
seem to be associated not only with
valproate but also with carbamazepine(Drug information on carbamazepine),
phenytoin, and polypharmacy.34
Although these investigators did not find
a link between NWS and cognitive
dysfunction, this is a topic in which
further research is badly needed.
Pregnant women with psychiatric conditions
must be adequately treated.
Pharmacologic treatment should be initiated or maintained when the disorder is
severe and the efficacy of the psychopharmacologic
approach has been
demonstrated, giving attention to nonpharmacologic
alternatives in order to
prevent the relapse of the disease in the
mother. Psychiatric clinical practice
shows that most pregnant women with
psychiatric conditions are treated with
polypharmacy,35 making it even more
complex to identify the effects of these
drugs on the newborn. Psychopharmacologic
agents can induce direct
effects on the newborn, as well as withdrawal
symptoms associated with their
suppression. The clinical picture of both
cases is often similar and confounding.
Nevertheless, NWS has clearly been
associated with TCAs, SSRIs, and
AEDs. However, with the exception of
AEDs, the clinical picture for most of
these drugs appears to be self-limited
and moderate, most frequently needing
only supportive therapy.
Dr Sanz is associate professor in clinical pharmacology
at the University of La Laguna in
Tenerife, Canary Islands, Spain, and a member
of the Review Panel of Experts of the WHO
Collaborating Centre for International Drug
Monitoring. He reports that he has no conflicts
of interest concerning the subject matter
of this article.
Dr De las Cuevas is associate professor of
psychiatry at the University of La Laguna in
Tenerife, Canary Islands, Spain, a specialist in
psychiatry with clinical responsibilities, and a
senior member of the Educational Liaisons
Network of the World Psychiatric Association.
He reports that he has no conflicts of interest
concerning the subject matter of this article.
Drugs Mentioned in This Article
Carbamazepine (Carbatrol, Tegretol, others)
Valproate/Valproic acid (Depakote, others)
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