Abstract
To the Editor
There is still a scarcity of evidence-based information about the safety of antipsychotic medications in pregnancy, which is surprising considering their increasing use to treat a number of disorders in pregnant women. As clinicians, we need to give the baby a good start by using the safest type and dose of antipsychotic medication that is absolutely necessary to maintain maternal mental health.
Mary is a 37-year-old woman with bipolar affective disorder who was prescribed an antipsychotic medication (700 mg quetiapine IR) during her pregnancy. This was her second pregnancy and her first was uncomplicated.
Mary is enrolled in the National Register of Antipsychotic Medication in Pregnancy (NRAMP) (ClinicalTrials.gov identifier: NCT00686946), which is an ongoing nationwide observational prospective study that seeks to provide evidence about the use of antipsychotics in pregnancy and assist clinicians and pregnant women in making informed decisions about treatment (Kulkarni et al., 2008). Participants are followed up during their pregnancy and delivery and then postnatally. The baby’s development is monitored for 12 months.
Antenatally, Mary developed obstetric hypertension in the 28th week. Her blood pressure was 180/140 mmHg but there was no proteinuria.
Pre-pregnancy, Mary’s weight was in the healthy range for her height. She should have gained between 11 kg and 16 kg in weight during pregnancy (Babycenter, 2013). Her weight gain of 18 kg is considered to be mildly excessive and could be due to a number of factors such as antipsychotic use during pregnancy, poor diet, and many other causes. She was scheduled for an elective caesarean section at 36.5 weeks.
Baby Jack was a preterm baby. He had mild respiratory distress and was admitted to the special care nursery for 2 days with good resolution of the symptoms. Baby Jack was also diagnosed with ‘neonatal medication withdrawal syndrome’ that resolved with time and conservative management.
Mary’s story has highlighted an important fact that the use of antipsychotics in pregnancy may have contributed to her high weight gain and obstetric hypertension plus her baby’s neonatal medication withdrawal syndrome. Further research is needed to investigate these potential associations.
Footnotes
Funding
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.