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Antipsychotics during pregnancy increased infants' need for special care

Nearly half of babies whose mothers took antipsychotics while pregnant required special care after birth, according to recent study findings published in PLOS One.

“There’s been little research on antipsychotic medication during pregnancy and if it affects babies,” Jayashri Kulkarni, PhD, of the Monash Alfred Psychiatry Research Centre in Melbourne, Australia, said in a press release. “The lack of data has made it very difficult for clinicians to say anything conclusively on how safe it is for babies. This new research confirms that most babies are born healthy, but many experience neonatal problems such as respiratory distress. This respiratory distress settled quickly with conservative management.”

Jayashri Kulkarni

Kulkarni and colleagues evaluated 147 pregnancies resulting in 142 live births to determine the effect of maternal antipsychotic use on offspring.

Thirty-seven percent of babies experienced respiratory distress and more than 40% required neonatal ICU care or special nursery care after birth.

Medication withdrawal symptoms were present in 15% of babies at birth. However, all were exposed to higher doses (4.4 mg per day) of antipsychotics at 12 weeks’ gestation compared with 2.7 mg per day (P=.162).

Eight babies had congenital anomalies such as atrial septal defect; cleft lip/palate and hydrocephalus; pulmonary atresia and atrial septal defect; abnormal renal collecting tubule and bilateral talipes; craniosynostosis, hypospadias and hypertelorism; gastroschisis and horseshoe kidney; bilateral hip dysplasia; and CHARGE association.

In the year after birth, most mothers reported being well, and 96 babies were reported as progressing well.

Statistical differences were not found in relation to birth weight, birth weeks, respiratory distress at delivery, special care admission, and mothers’ antenatal and postnatal Positive and Negative Syndrome Scale (PANSS) scores between psychosis and bipolar groups.

There was a six times increased likelihood of babies experiencing respiratory distress if their mothers use mood stabilizers during pregnancy compared with those whose mothers did not. There was also increased odds (13.4%) of being admitted to special care after delivery if mothers had higher total doses of primary and secondary antipsychotic medicine in risperidone in the 12 weeks before birth. 

“Most of the antipsychotics taken by women in pregnancy, that are required to treat severe mental illness, appear to result in overall good outcomes for babies,” Kulkarni told Healio.com. “However, special care needs to be provided in the antenatal period for the woman and specialist health care facilities are needed for the newborn in the short term.”

Jayashri Kulkarni, PhD, can be reached at jayashri.kulkarni@monash.edu.

Disclosure: See the study for a full list of researchers’ financial disclosures.