Vivien Burt, Professor Emeritus of Psychiatry at UCLA, discusses the intricate decision-making process surrounding atypical antipsychotics use during pregnancy, particularly for women with bipolar disorder. She highlights recent research showing no significant risk of major birth defects, emphasizing the need to balance maternal mental health with fetal safety. The conversation stresses the importance of effective communication between healthcare providers and patients to navigate treatment benefits and potential risks for newborns.
Recent studies indicate atypical antipsychotics in early pregnancy do not significantly increase congenital malformation risks for mothers with bipolar disorder.
Neonates may experience extrapyramidal side effects post-delivery, highlighting the need for careful monitoring despite benefits for maternal mental health.
Deep dives
Safety of Atypical Antipsychotics During Pregnancy
Current research indicates that the use of atypical antipsychotics during the first trimester of pregnancy is not associated with an increased risk of major congenital malformations. Studies, including the ongoing National Pregnancy Registry for Atypical Antipsychotics, suggest that these medications do not present a significant risk of teratogenicity. A large Japanese cohort study corroborates these findings, showing no notable pattern of malformations in women exposed to atypical antipsychotics. This data underscores that continuing treatment with these medications for pregnant women with serious psychiatric conditions, such as bipolar disorder, may be a prudent and safe choice.
Post-Delivery Observations and Risks
While atypical antipsychotics may not increase the risk of congenital malformations, there are potential concerns for neonates following delivery due to extrapyramidal side effects. Symptoms such as agitation, tremors, and feeding difficulties may occur, necessitating close monitoring in a special care nursery for approximately 48 hours postpartum. The FDA encourages healthcare providers to inform parents about these risks, yet emphasizes that these symptoms can often be managed effectively. Therefore, clinicians must balance the benefits of maintaining maternal mental health against the possibility of these side effects in newborns.
In this episode, we explore the use of atypical antipsychotics during pregnancy for women with bipolar disorder. We discuss recent research findings, potential risks, and the delicate balance between managing maternal mental health and fetal safety. How do clinicians approach this challenging clinical decision?
Faculty: Vivien Burt, M.D. Host: Richard Seeber, M.D.