Advertisement

Management of Bipolar Disease in Pregnancy and Lactation

  • Carol Swetlik
  • Adele C. Viguera
Mood Disorders (C Nemeroff and J Newport, Section Editors)
  • 11 Downloads
Part of the following topical collections:
  1. Topical Collection on Mood Disorders

Abstract

Purpose of review

Bipolar disorder is a psychiatric disorder that commonly affects women of reproductive age. Many women with bipolar disorder require treatment during pregnancy and the post-partum period to optimize their health. The following review examines recent evidence regarding the risks and benefits of using commonly prescribed medications for bipolar disorder in pregnancy and lactation.

Recent findings

Current research has not found significant and consistent risks with use of atypical antipsychotics compared to other psychotropic agents, and some previously established teratogens, such as lithium, appear to carry lower risk of malformation than initially reported. Studies that examine the impact of polytherapy, however, are needed.

Summary

A patient-centered approach with minimal effective dosing of necessary medications is likely to produce the best outcome for optimization and simplification of the medical regimen for mother and child.

Keywords

Bipolar Women’s Mental Health Pregnancy Lactation Atypical antipsychotics Second-generation antipsychotics Reproductive safety 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Merikangas KR, Jin R, He J-P, Kessler RC, Lee S, Sampson NA, et al. Prevalence and correlates of bipolar spectrum disorder in the World Mental Health Survey Initiative. Arch Gen Psychiatry. 2011;68:241.  https://doi.org/10.1001/archgenpsychiatry.2011.12.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Coughlin CG, Blackwell KA, Bartley C, Hay M, Yonkers KA, Bloch MH. Obstetric and neonatal outcomes after antipsychotic medication exposure in pregnancy. Obstet Gynecol. 2015;125:1224–35.  https://doi.org/10.1097/AOG.0000000000000759.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Cohen LS, Friedman JM, Jefferson JW, Johnson EM, Weiner ML. A reevaluation of risk of in utero exposure to lithium. JAMA. 1994;271:146.  https://doi.org/10.1001/jama.1994.03510260078033.CrossRefPubMedGoogle Scholar
  4. 4.
    Byatt N, Cox L, Moore Simas TA, Biebel K, Sankaran P, Swartz HA, et al. Access to pharmacotherapy amongst women with bipolar disorder during pregnancy: a preliminary study. Psychiatr Q. 2017:1–8.  https://doi.org/10.1007/s11126-017-9525-8.
  5. 5.
    Viguera AC, Nonacs R, Cohen LS, Tondo L, Murray A, Baldessarini RJ. Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. Am J Psychiatry. 2000;157:179–84.  https://doi.org/10.1176/appi.ajp.157.2.179. CrossRefPubMedGoogle Scholar
  6. 6.
    Viguera AC, Whitfield T, Baldessarini RJ, Newport DJ, Stowe Z, Reminick A, et al. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatry. 2007;164:1817–24.  https://doi.org/10.1176/appi.ajp.2007.06101639.CrossRefPubMedGoogle Scholar
  7. 7.
    Tosato S, Albert U, Tomassi S, Iasevoli F, Carmassi C, Ferrari S, et al. A systematized review of atypical antipsychotics in pregnant women. J Clin Psychiatry. 2017;78:e477–89.  https://doi.org/10.4088/JCP.15r10483. CrossRefPubMedGoogle Scholar
  8. 8.
    McKenna K, Koren G, Tetelbaum M, Wilton L, Shakir S, Diav-Citrin O, et al. Pregnancy outcome of women using atypical antipsychotic drugs: a prospective comparative study. J. Clin. Psychiatry. 2005;66:444–9 quiz 546. http://www.ncbi.nlm.nih.gov/pubmed/15816786. Accessed 24 Oct 2017.CrossRefGoogle Scholar
  9. 9.
    Sharma V, Sharma S. Peripartum management of bipolar disorder: what do the latest guidelines recommend? Expert Rev Neurother. 2017;17:335–44.  https://doi.org/10.1080/14737175.2017.1243470.CrossRefPubMedGoogle Scholar
  10. 10.
    Stephenson CP, Karanges E, McGregor IS. Trends in the utilisation of psychotropic medications in Australia from 2000 to 2011. Aust N Z J Psychiatry. 2013;47:74–87.  https://doi.org/10.1177/0004867412466595.CrossRefPubMedGoogle Scholar
  11. 11.
    Broeks SC, Thisted Horsdal H, Glejsted Ingstrup K, Gasse C. Psychopharmacological drug utilization patterns in pregnant women with bipolar disorder—a nationwide register-based study. J Affect Disord. 2017;210:158–65.  https://doi.org/10.1016/j.jad.2016.12.001.CrossRefPubMedGoogle Scholar
  12. 12.
    Vieira Da Silva Magalhães P, Kapczinski F, Kauer-Sant’Anna M. Use of contraceptive methods among women treated for bipolar disorder. Arch. Womens. Ment. Health. 2009;12:183–5.  https://doi.org/10.1007/s00737-009-0060-y.CrossRefGoogle Scholar
  13. 13.
    Grof P, Robbins W, Alda M, Berghoefer A, Vojtechovsky M, Nilsson A, et al. Protective effect of pregnancy in women with lithium-responsive bipolar disorder. J Affect Disord. 2000;61:31–9 http://www.ncbi.nlm.nih.gov/pubmed/11099738. Accessed 26 Oct 2017.CrossRefGoogle Scholar
  14. 14.
    Kendell RE, Chalmers JC, Platz C. Epidemiology of puerperal psychoses. Br J Psychiatry. 1987;150:662–73 http://www.ncbi.nlm.nih.gov/pubmed/3651704. Accessed 26 Oct 2017.CrossRefGoogle Scholar
  15. 15.
    Lier L, Kastrup M, Rafaelsen OJ. Psychiatric illness in relation to pregnancy and childbirth II. Diagnostic profiles, psychosocial and perinatal aspects. Nord Psykiatr Tidsskr. 1989;43:535–42.  https://doi.org/10.3109/08039488909103252.CrossRefGoogle Scholar
  16. 16.
    Freeman MP, Smith KW, Freeman SA, McElroy SL, Kmetz GE, Wright R, et al. The impact of reproductive events on the course of bipolar disorder in women. J. Clin. Psychiatry. 2002;63:284–7 http://www.ncbi.nlm.nih.gov/pubmed/12004800. Accessed 22 Oct 2017.CrossRefGoogle Scholar
  17. 17.
    Galbally M, Snellen M, Power J. Antipsychotic drugs in pregnancy: a review of their maternal and fetal effects. Ther Adv Drug Saf. 2014;5:100–9.  https://doi.org/10.1177/2042098614522682.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Baldessarini RJ, Viguera AC. Neuroleptic withdrawal in schizophrenic patients. Arch Gen Psychiatry. 1995;52:189–92 http://www.ncbi.nlm.nih.gov/pubmed/7872842. Accessed 26 Oct 2017.CrossRefGoogle Scholar
  19. 19.
    Di Florio A, Forty L, Gordon-Smith K, Heron J, Jones L, Craddock N, et al. Perinatal episodes across the mood disorder spectrum. JAMA Psychiatry. 2013;70:168.  https://doi.org/10.1001/jamapsychiatry.2013.279.CrossRefPubMedGoogle Scholar
  20. 20.
    Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJM, Kushner SA, Bergink V. Risk of postpartum relapse in bipolar disorder and postpartum psychosis: a systematic review and meta-analysis. Am J Psychiatry. 2016;173:117–27.  https://doi.org/10.1176/appi.ajp.2015.15010124.CrossRefPubMedGoogle Scholar
  21. 21.
    Maina G, Rosso G, Aguglia A, Bogetto F. Recurrence rates of bipolar disorder during the postpartum period: a study on 276 medication-free Italian women. Arch Womens Ment Health. 2014;17:367–72.  https://doi.org/10.1007/s00737-013-0405-4.CrossRefPubMedGoogle Scholar
  22. 22.
    Payne JL, Mackinnon DF, Mondimore FM, Mcinnis MG, Schweizer B, Zamoiski RB, et al. Familial aggregation of postpartum mood symptoms in bipolar disorder pedigrees. Bipolar Disord. 2008;10:38–44.  https://doi.org/10.1111/j.1399-5618.2008.00455.x.CrossRefPubMedGoogle Scholar
  23. 23.
    Brockington IF, Cernik KF, Schofield EM, Downing AR, Francis AF, Keelan C. Puerperal psychosis. Arch Gen Psychiatry. 1981;38:829.  https://doi.org/10.1001/archpsyc.1981.01780320109013. CrossRefPubMedGoogle Scholar
  24. 24.
    Rohde A, Marneros A. Bipolar disorders during pregnancy, post partum and in menopause. In: Bipolar disord. Dordrecht: Kluwer Academic Publishers; 2000. p. 127–37.  https://doi.org/10.1007/0-306-47521-9_6.CrossRefGoogle Scholar
  25. 25.
    Moses-Kolko EL, Hipwell AE. First-onset postpartum psychiatric disorders portend high 1-year unnatural-cause ,mortality risk. Am J Psychiatry. 2016;173:559–61.  https://doi.org/10.1176/appi.ajp.2016.16030317.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Kendell RE, McGuire RJ, Connor Y, Cox JL. Mood changes in the first three weeks after childbirth. J Affect Disord. 1981;3:317–26.  https://doi.org/10.1016/0165-0327(81)90001-X.CrossRefPubMedGoogle Scholar
  27. 27.
    Blackmore ER, Jones I, Doshi M, Haque S, Holder R, Brockington I, et al. Obstetric variables associated with bipolar affective puerperal psychosis. Br J Psychiatry. 2006;188:32–6.  https://doi.org/10.1192/BJP.188.1.32.CrossRefPubMedGoogle Scholar
  28. 28.
    Jones I, Craddock N. Familiality of the puerperal trigger in bipolar disorder: results of a family study. Am J Psychiatry. 2001;158:913–7.  https://doi.org/10.1176/appi.ajp.158.6.913.CrossRefPubMedGoogle Scholar
  29. 29.
    Bergink V, Bouvy PF, Vervoort JSP, Koorengevel KM, Steegers EAP, Kushner SA. Prevention of postpartum psychosis and mania in women at high risk. Am J Psychiatry. 2012;169:609–15.  https://doi.org/10.1176/appi.ajp.2012.11071047.CrossRefPubMedGoogle Scholar
  30. 30.
    Austin MP. Puerperal affective psychosis: is there a case for lithium prophylaxis? Br J Psychiatry. 1992;161:692–4 http://www.ncbi.nlm.nih.gov/pubmed/1422621. Accessed 11 Feb 2018.CrossRefGoogle Scholar
  31. 31.
    Pacchiarotti I, León-Caballero J, Murru A, Verdolini N, Furio MA, Pancheri C, et al. Mood stabilizers and antipsychotics during breastfeeding: focus on bipolar disorder. Eur Neuropsychopharmacol. 2016;26:1562–78.  https://doi.org/10.1016/j.euroneuro.2016.08.008.CrossRefPubMedGoogle Scholar
  32. 32.
    Reis M, Källén B. Maternal use of antipsychotics in early pregnancy and delivery outcome. J Clin Psychopharmacol. 2008;28:279–88.  https://doi.org/10.1097/JCP.0b013e318172b8d5.CrossRefPubMedGoogle Scholar
  33. 33.
    Panchaud A, Hernandez-Diaz S, Freeman MP, Viguera AC, MacDonald SC, Sosinsky AZ, et al. Use of atypical antipsychotics in pregnancy and maternal gestational diabetes. J Psychiatr Res. 2017;95:84–90.  https://doi.org/10.1016/j.jpsychires.2017.07.025.CrossRefPubMedGoogle Scholar
  34. 34.
    Bodén R, Lundgren M, Brandt L, Reutfors J, Kieler H. Antipsychotics during pregnancy. Arch Gen Psychiatry. 2012;69:715–21.  https://doi.org/10.1001/archgenpsychiatry.2011.1870. CrossRefPubMedGoogle Scholar
  35. 35.
    Bodén R, Lundgren M, Brandt L, Reutfors J, Andersen M, Kieler H. Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: population based cohort study. BMJ. 2012;345:e7085.  https://doi.org/10.1136/BMJ.E7085.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Newport DJ, Viguera AC, Beach AJ, Ritchie JC, Cohen LS, Stowe ZN. Lithium placental passage and obstetrical outcome: implications for clinical management during late pregnancy. Am J Psychiatry. 2005;162:2162–70.  https://doi.org/10.1176/appi.ajp.162.11.2162.CrossRefPubMedGoogle Scholar
  37. 37.
    A.M. Bank, Stowe ZN, Newport DJ, Ritchie JC, Pennell PB. Placental passage of antiepileptic drugs at delivery and neonatal outcomes. Epilepsia. 2017;58:e82–6.  https://doi.org/10.1111/epi.13733.CrossRefGoogle Scholar
  38. 38.
    Raha S, Taylor VH, Holloway AC. Effect of atypical antipsychotics on fetal growth: is the placenta involved? J Pregnancy. 2012;2012:315203.  https://doi.org/10.1155/2012/315203.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Babu GN, Desai G, Tippeswamy H, Chandra PS. Birth weight and use of olanzapine in pregnancy. J Clin Psychopharmacol. 2010;30:331–2.  https://doi.org/10.1097/JCP.0b013e3181db8734.CrossRefPubMedGoogle Scholar
  40. 40.
    Newport DJ, Calamaras MR, DeVane CL, Donovan J, Beach AJ, Winn S, et al. Atypical antipsychotic administration during late pregnancy: placental passage and obstetrical outcomes. Am J Psychiatry. 2007;164:1214–20.  https://doi.org/10.1176/appi.ajp.2007.06111886.CrossRefPubMedGoogle Scholar
  41. 41.
    Newham JJ, Thomas SH, MacRitchie K, McElhatton PR, McAllister-Williams RH. Birth weight of infants after maternal exposure to typical and atypical antipsychotics: prospective comparison study. Br J Psychiatry. 2008;192:333–7.  https://doi.org/10.1192/bjp.bp.107.041541.CrossRefPubMedGoogle Scholar
  42. 42.
    Mei-Dan E, Ray JG, Vigod SN. Perinatal outcomes among women with bipolar disorder: a population-based cohort study. Am J Obstet Gynecol. 2015;212:367.e1–8.  https://doi.org/10.1016/j.ajog.2014.10.020.CrossRefGoogle Scholar
  43. 43.
    Ennis ZN, Damkier P. Pregnancy exposure to olanzapine, quetiapine, risperidone, aripiprazole and risk of congenital malformations. A systematic review. Basic Clin Pharmacol Toxicol. 2015;116:315–20.  https://doi.org/10.1111/bcpt.12372.CrossRefPubMedGoogle Scholar
  44. 44.
    •• Cohen LS, Viguera AC, McInerney KA, Freeman MP, Sosinsky AZ, Moustafa D, et al. Reproductive safety of second-generation antipsychotics from the Massachusetts General Hospital National Pregnancy Registry for Atypical Antipsychotics. Am J Psychiatry. 2016;173:263–70. This paper details the current reproductive safety findings of the National Pregnancy Registry for Atypical Antipsychotics, which is a large on-going Registry for enrolling pregnancy women with mental health conditions.CrossRefGoogle Scholar
  45. 45.
    Johnson KC, LaPrairie JL, Brennan PA, Stowe ZN, Newport DJ. Prenatal antipsychotic exposure and neuromotor performance during infancy. Arch Gen Psychiatry. 2012;69:787–94.  https://doi.org/10.1001/archgenpsychiatry.2012.160. CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Peng M, Gao K, Ding Y, Ou J, Calabrese JR, Wu R, et al. Effects of prenatal exposure to atypical antipsychotics on postnatal development and growth of infants: a case-controlled, prospective study. Psychopharmacology. 2013;228:577–84.  https://doi.org/10.1007/s00213-013-3060-6.CrossRefPubMedGoogle Scholar
  47. 47.
    Santucci AK, Singer LT, Wisniewski SR, Luther JF, Eng HF, Sit DK, et al. One-year developmental outcomes for infants of mothers with bipolar disorder. J Clin Psychiatry. 2017;78:1083–90.  https://doi.org/10.4088/JCP.15m10535.CrossRefPubMedGoogle Scholar
  48. 48.
    Nora JJ, Nora AH, Toews WH. Letter: lithium, Ebstein’s anomaly, and other congenital heart defects. Lancet. 1974;2:594–5 http://www.ncbi.nlm.nih.gov/pubmed/4140306. Accessed 23 Oct 2017.CrossRefGoogle Scholar
  49. 49.
    Weinstein MR. Lithium treatment of women during pregnancy and in the post-delivery period. Handbook of Lithium Therapy. 1980:421–30.  https://doi.org/10.1007/978-94-011-7197-7_48.
  50. 50.
    • Patorno E, Huybrechts KF, Bateman BT, Cohen JM, Desai RJ, Mogun H, et al. Lithium use in pregnancy and the risk of cardiac malformations. N Engl J Med. 2017;376:2245–54. This large database study details the dose-dependent risk of cardiac malformation following lithium exposure and clarifies the reproductive safety concerns surrounding the use of lithium in pregnancy.CrossRefGoogle Scholar
  51. 51.
    Schou M. What happened later to the lithium babies? A follow-up study of children born without malformations. Acta Psychiatr Scand. 1976;54:193–7 http://www.ncbi.nlm.nih.gov/pubmed/970196. Accessed 11 Feb 2018.CrossRefGoogle Scholar
  52. 52.
    van der Lugt NM, van de Maat JS, van Kamp IL, Knoppert-van der Klein EAM, Hovens JGFM, Walther FJ. Fetal, neonatal and developmental outcomes of lithium-exposed pregnancies. Early Hum Dev. 2012;88:375–8.  https://doi.org/10.1016/j.earlhumdev.2011.09.013.CrossRefPubMedGoogle Scholar
  53. 53.
    Austgulen Westin A, Brekke M, Molden E, Skogvoll E, Aadal M, Spigset O. Changes in drug disposition of lithium during pregnancy: a retrospective observational study of patient data from two routine therapeutic drug monitoring services in Norway. n.d.  https://doi.org/10.1007/978-94-011-7197-7.
  54. 54.
    American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. (n.d.). http://pediatrics.aappublications.org/content/pediatrics/108/3/776.full.pdf. Accessed 11 Feb 2018.
  55. 55.
    Bogen DL, Sit D, Genovese A, Wisner KL. Three cases of lithium exposure and exclusive breastfeeding. Arch Womens Ment Health. 2012;15:69–72.  https://doi.org/10.1007/s00737-012-0257-3.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Morrow J, Russell A, Guthrie E, Parsons L, Robertson I, Waddell R, et al. Malformation risks of antiepileptic drugs in pregnancy: a prospective study from the UK Epilepsy and Pregnancy Register. J Neurol Neurosurg Psychiatry. 2006;77:193–8.  https://doi.org/10.1136/jnnp.2005.074203. CrossRefPubMedGoogle Scholar
  57. 57.
    Harden CL, Meador KJ, Pennell PB, Hauser WA, Gronseth GS, French JA, et al. Practice parameter update: management issues for women with epilepsy—focus on pregnancy (an evidence-based review): teratogenesis and perinatal outcomes: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73:133–41.  https://doi.org/10.1212/WNL.0b013e3181a6b312. CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Adab N, Kini U, Vinten J, Ayres J, Baker G, Clayton-Smith J, et al. The longer term outcome of children born to mothers with epilepsy. J Neurol Neurosurg Psychiatry. 2004;75:1575–83.  https://doi.org/10.1136/jnnp.2003.029132. CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, et al. NEAD Study Group, Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study. Lancet Neurol. 2013;12:244–52.  https://doi.org/10.1016/S1474-4422(12)70323-X. CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    von Unruh GE, Froescher W, Hoffmann F, Niesen M. Valproic acid in breast milk: how much is really there? Ther Drug Monit. 1984;6:272–6 http://www.ncbi.nlm.nih.gov/pubmed/6438834. Accessed 24 Oct 2017.CrossRefGoogle Scholar
  61. 61.
    Frey B, Schubiger G, Musy JP. Transient cholestatic hepatitis in a neonate associated with carbamazepine exposure during pregnancy and breast-feeding. Eur J Pediatr. 1990;150:136–8.  https://doi.org/10.1007/BF02072057.CrossRefPubMedGoogle Scholar
  62. 62.
    Frey B, Braegger CP, Ghelfi D. Neonatal cholestatic hepatitis from carbamazepine exposure during pregnancy and breast feeding. Ann Pharmacother. 2002;36:644–7.  https://doi.org/10.1345/aph.1A326.CrossRefPubMedGoogle Scholar
  63. 63.
    Merlob P, Mor N, Litwin A. Transient hepatic dysfunction in an infant of an epileptic mother treated with carbamazepine during pregnancy and breastfeeding. Ann Pharmacother. 1992;26:1563–5.  https://doi.org/10.1177/106002809202601215.CrossRefPubMedGoogle Scholar
  64. 64.
    Meador KJ, Baker GA, Browning N, Clayton-Smith J, Combs-Cantrell DT, Cohen M, et al. Effects of breastfeeding in children of women taking antiepileptic drugs. Neurology. 2010;75:1954–60.  https://doi.org/10.1212/WNL.0b013e3181ffe4a9.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, et al. Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 years. JAMA Pediatr. 2014.  https://doi.org/10.1001/jamapediatrics.2014.118.
  66. 66.
    Piontek CM, Baab S, Peindl KS, Wisner KL. Serum valproate levels in 6 breastfeeding mother-infant pairs. J. Clin. Psychiatry. 2000;61:170–2 http://www.ncbi.nlm.nih.gov/pubmed/10817100. Accessed 11 Feb 2018.CrossRefGoogle Scholar
  67. 67.
    Veiby G, Bjørk M, Engelsen BA, Gilhus NE. Epilepsy and recommendations for breastfeeding. n.d.  https://doi.org/10.1016/j.seizure.2015.02.013.
  68. 68.
    Diav-Citrin O, Shechtman S, Arnon J, Ornoy A. Is carbamazepine teratogenic? A prospective controlled study of 210 pregnancies. Neurology. 2001;57:321–4 http://www.ncbi.nlm.nih.gov/pubmed/11468320. Accessed 26 Oct 2017.CrossRefGoogle Scholar
  69. 69.
    Hiilesmaa VK, Teramo K, Granström ML, Bardy AH. Fetal head growth retardation associated with maternal antiepileptic drugs. Lancet. 1981;2:165–7 http://www.ncbi.nlm.nih.gov/pubmed/6114242. Accessed 23 Oct 2017.CrossRefGoogle Scholar
  70. 70.
    Gaily E, Kantola-Sorsa E, Hiilesmaa V, Isoaho M, Matila R, Kotila M, et al. Normal intelligence in children with prenatal exposure to carbamazepine. Neurology. 2004;62:28–32.  https://doi.org/10.1212/WNL.62.1.28.CrossRefPubMedGoogle Scholar
  71. 71.
    Davanzo R, Dal Bo S, Bua J, Copertino M, Zanelli E, Matarazzo L. Antiepileptic drugs and breastfeeding. Ital J Pediatr. 2013;39:50.  https://doi.org/10.1186/1824-7288-39-50.CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    Bar-Oz B, Nulman I, Koren G, Ito S. Anticonvulsants and breast feeding: a critical review. Paediatr Drugs. n.d.;2:113–26 http://www.ncbi.nlm.nih.gov/pubmed/10937463. Accessed 11 Feb 2018.
  73. 73.
    Kuhnz W, Jäger-Roman E, Rating D, Deichl A, Kunze J, Helge H, et al. Carbamazepine and carbamazepine-10,11-epoxide during pregnancy and postnatal period in epileptic mother and their nursed infants: pharmacokinetics and clinical effects. Pediatr Pharmacol (New York). 1983;3:199–208 http://www.ncbi.nlm.nih.gov/pubmed/6677873. Accessed 24 Oct 2017.Google Scholar
  74. 74.
    Montouris G. Safety of the newer antiepileptic drug oxcarbazepine during pregnancy. Curr Med Res Opin. 2005;21:693–701.  https://doi.org/10.1185/030079905X43640.CrossRefPubMedGoogle Scholar
  75. 75.
    Veiby G, Daltveit AK, Engelsen BA, Gilhus NE. Fetal growth restriction and birth defects with newer and older antiepileptic drugs during pregnancy. J Neurol. 2014;261:579–88.  https://doi.org/10.1007/s00415-013-7239-x.CrossRefPubMedGoogle Scholar
  76. 76.
    Lutz UC, Wiatr G, Gaertner H-J, Bartels M. Oxcarbazepine treatment during breast-feeding: a case report. J Clin Psychopharmacol. 2007;27:730–2.  https://doi.org/10.1097/JCP.0b013e31815a5819.CrossRefPubMedGoogle Scholar
  77. 77.
    Wesseloo R, Liu X, Clark CT, Kushner SA, Munk-Olsen T, Bergink V. Risk of postpartum episodes in women with bipolar disorder after lamotrigine or lithium use during pregnancy: a population-based cohort study. J Affect Disord. 2017;218:394–7.  https://doi.org/10.1016/j.jad.2017.04.070.CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.
    Pennell PB, Peng L, Newport DJ, Ritchie JC, Koganti A, Holley DK, et al. Lamotrigine in pregnancy: clearance, therapeutic drug monitoring, and seizure frequency. Neurology. 2008;70:2130–6.  https://doi.org/10.1212/01.wnl.0000289511.20864.2a.CrossRefPubMedGoogle Scholar
  79. 79.
    Fotopoulou C, Kretz R, Bauer S, Schefold JC, Schmitz B, Dudenhausen JW, et al. Prospectively assessed changes in lamotrigine-concentration in women with epilepsy during pregnancy, lactation and the neonatal period. Epilepsy Res. 2009;85:60–4.  https://doi.org/10.1016/j.eplepsyres.2009.02.011.CrossRefPubMedGoogle Scholar
  80. 80.
    Pennell PB, Klein AM, Browning N, Baker GA, Clayton-Smith J, Kalayjian LA, et al. Differential effects of antiepileptic drugs on neonatal outcomes. Epilepsy Behav. 2012;24:449–56.  https://doi.org/10.1016/j.yebeh.2012.05.010. CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    Holmes LB, Baldwin EJ, Smith CR, Habecker E, Glassman L, Wong SL, et al. Increased frequency of isolated cleft palate in infants exposed to lamotrigine during pregnancy. Neurology. 2008;70:2152–8.  https://doi.org/10.1212/01.wnl.0000304343.45104.d6.CrossRefPubMedGoogle Scholar
  82. 82.
    Dolk H, Wang H, Loane M, Morris J, Garne E, Addor M-C, et al. Lamotrigine use in pregnancy and risk of orofacial cleft and other congenital anomalies. Neurology. 2016;86:1716–25.  https://doi.org/10.1212/WNL.0000000000002540.CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Cunnington MC, Weil JG, Messenheimer JA, Ferber S, Yerby M, Tennis P. Final results from 18 years of the International Lamotrigine Pregnancy Registry. Neurology. 2011;76:1817–23.  https://doi.org/10.1212/WNL.0b013e31821ccd18.CrossRefPubMedGoogle Scholar
  84. 84.
    Veiby G, Daltveit AK, Schjølberg S, Stoltenberg C, Øyen A-S, Vollset SE, et al. Exposure to antiepileptic drugs in utero and child development: a prospective population-based study. Epilepsia. 2013;54:1462–72.  https://doi.org/10.1111/epi.12226.CrossRefPubMedPubMedCentralGoogle Scholar
  85. 85.
    Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, et al. Effects of fetal antiepileptic drug exposure: outcomes at age 4.5 years. Neurology. 2012.  https://doi.org/10.1212/WNL.0b013e318250d824.
  86. 86.
    Bromley RL, Mawer G, Love J, Kelly J, Purdy L, McEwan L, et al. Liverpool and Manchester Neurodevelopment Group [LMNDG], Early cognitive development in children born to women with epilepsy: a prospective report. Epilepsia. 2010;51:2058–65.  https://doi.org/10.1111/j.1528-1167.2010.02668.x. CrossRefPubMedGoogle Scholar
  87. 87.
    Newport DJ, Pennell PB, Calamaras MR, Ritchie JC, Newman M, Knight B, et al. Lamotrigine in breast milk and nursing infants: determination of exposure. Pediatrics. 2008;122:e223–31.  https://doi.org/10.1542/peds.2007-3812.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Nordmo E, Aronsen L, Wasland K, Småbrekke L, Vorren S. Severe apnea in an infant exposed to lamotrigine in breast milk. Ann Pharmacother. 2009;43:1893–7.  https://doi.org/10.1345/aph.1M254.CrossRefPubMedGoogle Scholar
  89. 89.
    Wakil L, Epperson CN, Gonzalez J, O’Reardon JP, Kim DR. Neonatal outcomes with the use of lamotrigine for bipolar disorder in pregnancy and breastfeeding: a case series and review of the literature. Psychopharmacol Bull. 2009;42:91–8 http://www.ncbi.nlm.nih.gov/pubmed/19752842. Accessed 18 Feb 2018.PubMedGoogle Scholar
  90. 90.
    Uguz F. Prophylactic use of olanzapine and quetiapine from pregnancy to the postpartum period in women with bipolar disorder: a case series. J Matern-Fetal Neo M. 2016:1–3.  https://doi.org/10.1080/14767058.2016.1256991.
  91. 91.
    Sharma V, Smith A, Mazmanian D. Olanzapine in the prevention of postpartum psychosis and mood episodes in bipolar disorder. Bipolar Disord. 2006;8:400–4.  https://doi.org/10.1111/j.1399-5618.2006.00335.x.CrossRefPubMedGoogle Scholar
  92. 92.
    Brunner E, Falk DM, Jones M, Dey DK, Shatapathy CC. Olanzapine in pregnancy and breastfeeding: a review of data from global safety surveillance. BMC Pharmacol Toxicol. 2013;14:38.  https://doi.org/10.1186/2050-6511-14-38.CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    Gentile S. Neurodevelopmental effects of prenatal exposure to psychotropic medications. Depress Anxiety. 2010;27:675–86.  https://doi.org/10.1002/da.20706.CrossRefPubMedGoogle Scholar
  94. 94.
    Gilad O, Merlob P, Stahl B, Klinger G. Outcome of infants exposed to olanzapine during breastfeeding. Breastfeed Med. 2011;6:55–8.  https://doi.org/10.1089/bfm.2010.0027.CrossRefPubMedGoogle Scholar
  95. 95.
    Gardiner SJ, Kristensen JH, Begg EJ, Hackett LP, Wilson DA, Ilett KF, et al. Transfer of olanzapine into breast milk, calculation of infant drug dose, and effect on breast-fed infants. Am J Psychiatry. 2003;160:1428–31.  https://doi.org/10.1176/appi.ajp.160.8.1428.CrossRefPubMedGoogle Scholar
  96. 96.
    Mehta TM, Van Lieshout RJ. A review of the safety of clozapine during pregnancy and lactation, Arch. Womens Ment Health. 2017;20:1–9.  https://doi.org/10.1007/s00737-016-0670-0. CrossRefGoogle Scholar
  97. 97.
    Stoner SC, Sommi RW, Marken PA, Anya I, Vaughn J. Clozapine use in two full-term pregnancies. J Clin Psychiatry. 1997;58:364–5 http://www.ncbi.nlm.nih.gov/pubmed/9515978. Accessed 24 Oct 2017.CrossRefGoogle Scholar
  98. 98.
    Guyon L, Auffret M, Coussemacq M, Béné J, Deruelle P, Gautier S. Alteration of the fetal heart rate pattern induced by the use of clozapine during pregnancy. Therapie. 2015;70:301–3.  https://doi.org/10.2515/therapie/2014214.CrossRefPubMedGoogle Scholar
  99. 99.
    Karakuła H, Szajer K, Rpila B, Grzywa A, Chuchra M. Clozapine and pregnancy—a case history. Pharmacopsychiatry. 2004;37:303–4.  https://doi.org/10.1055/s-2004-832689. CrossRefPubMedGoogle Scholar
  100. 100.
    Shao P, Ou J, Peng M, Zhao J, Chen J, Wu R. Effects of clozapine and other atypical antipsychotics on infants development who were exposed to as fetus: a post-hoc analysis. PLoS One. 2015;10:e0123373.  https://doi.org/10.1371/journal.pone.0123373.CrossRefPubMedPubMedCentralGoogle Scholar
  101. 101.
    Mendhekar DN. Possible delayed speech acquisition with clozapine therapy during pregnancy and lactation. J Neuropsychiatr Clin Neurosci. 2007;19:196–7.  https://doi.org/10.1176/jnp.2007.19.2.196.CrossRefGoogle Scholar
  102. 102.
    Sreeraj VS, Venkatasubramanian G, Safety of clozapine in a woman with triplet pregnancy: a case report. Asian J Psychiatr. 2016;22:67–8.  https://doi.org/10.1016/j.ajp.2016.04.009.CrossRefPubMedGoogle Scholar
  103. 103.
    Barnas C, Bergant A, Hummer M, Saria A, Fleischhacker WW. Clozapine concentrations in maternal and fetal plasma, amniotic fluid, and breast milk. Am J Psychiatry. 1994;151:945.  https://doi.org/10.1176/ajp.151.6.945.CrossRefPubMedGoogle Scholar
  104. 104.
    Dev VKPJ. Adverse event profile and safety of clozapine. Rev Contemp Pharmacother. 1995;197–208.Google Scholar
  105. 105.
    Coppola D, Russo LJ, Kwarta RF, Varughese R, Schmider J. Evaluating the postmarketing experience of risperidone use during pregnancy: pregnancy and neonatal outcomes. Drug Saf. 2007;30:247–64 http://www.ncbi.nlm.nih.gov/pubmed/17343431. Accessed 9 Oct 2017.CrossRefGoogle Scholar
  106. 106.
    Ilett KF, Hackett LP, Kristensen JH, Vaddadi KS, Gardiner SJ, Begg EJ. Transfer of risperidone and 9-hydroxyrisperidone into human milk. Ann Pharmacother. 2004;38:273–6.  https://doi.org/10.1345/aph.1D326.CrossRefPubMedGoogle Scholar
  107. 107.
    Hill RC, McIvor RJ, Wojnar-Horton RE, Hackett LP, Ilett KF. Risperidone distribution and excretion into human milk: case report and estimated infant exposure during breast-feeding. J Clin Psychopharmacol. 2000;20:285–6 http://www.ncbi.nlm.nih.gov/pubmed/10770482. Accessed 24 Oct 2017.CrossRefGoogle Scholar
  108. 108.
    Aichhorn W, Stuppaeck C, Whitworth AB. Risperidone and breast-feeding. J Psychopharmacol. 2005;19:211–3.  https://doi.org/10.1177/0269881105049044.CrossRefPubMedGoogle Scholar
  109. 109.
    Einarson A, Boskovic R. Use and safety of antipsychotic drugs during pregnancy. J Psychiatr Pract. 2009;15:183–92.  https://doi.org/10.1097/01.pra.0000351878.45260.94.CrossRefPubMedGoogle Scholar
  110. 110.
    Tényi T, Trixler M, Keresztes Z. Quetiapine and pregnancy. Am J Psychiatry. 2002;159:674.  https://doi.org/10.1176/appi.ajp.159.4.674.CrossRefPubMedGoogle Scholar
  111. 111.
    Misri S, Corral M, Wardrop AA, Kendrick K. Quetiapine augmentation in lactation. J Clin Psychopharmacol. 2006;26:508–11.  https://doi.org/10.1097/01.jcp.0000236656.70544.f3.CrossRefPubMedGoogle Scholar
  112. 112.
    Watanabe N, Kasahara M, Sugibayashi R, Nakamura T, Nakajima K, Watanabe O, et al. Perinatal use of aripiprazole. J Clin Psychopharmacol. 2011;31:377–9.  https://doi.org/10.1097/JCP.0b013e318218c400.CrossRefPubMedGoogle Scholar
  113. 113.
    Lutz UC, Hiemke C, Wiatr G, Farger G, Arand J, Wildgruber D. Aripiprazole in pregnancy and lactation. J Clin Psychopharmacol. 2010;30:204–5.  https://doi.org/10.1097/JCP.0b013e3181d27c7d.CrossRefPubMedGoogle Scholar
  114. 114.
    Peindl KS, Masand P, Mannelli P, Narasimhan M, Patkar A. Polypharmacy in pregnant women with major psychiatric illness: a pilot study. J Psychiatr Pract. 2007;13:385–92.  https://doi.org/10.1097/01.pra.0000300124.83945.b8.CrossRefPubMedGoogle Scholar
  115. 115.
    Markowitz JS, Wells BG, Carson WH. Interactions between antipsychotic and antihypertensive drugs. Ann Pharmacother. 1995;29:603–9.  https://doi.org/10.1177/106002809502900610.CrossRefPubMedGoogle Scholar
  116. 116.
    Yonkers K a, Wisner KL, Stowe Z, Leibenluft E, Cohen L, Miller L, et al. Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry. 2004;161:608–20.  https://doi.org/10.1176/appi.ajp.161.4.608.CrossRefPubMedGoogle Scholar
  117. 117.
    Correll CU, Sikich L, Reeves G, Riddle M. Metformin for antipsychotic-related weight gain and metabolic abnormalities: when, for whom, and for how long? Am J Psychiatry. 2013;170:947–52.  https://doi.org/10.1176/appi.ajp.2013.13060771.CrossRefPubMedGoogle Scholar
  118. 118.
    Morgan VA, Croft ML, Valuri GM, Zubrick SR, Bower C, McNeil TF, et al. Intellectual disability and other neuropsychiatric outcomes in high-risk children of mothers with schizophrenia, bipolar disorder and unipolar major depression. Br J Psychiatry. 2012;200:282–9.  https://doi.org/10.1192/bjp.bp.111.093070.CrossRefPubMedGoogle Scholar
  119. 119.
    Holmes LB, Mittendorf R, Shen A, Smith CR, Hernandez-Diaz S. Fetal effects of anticonvulsant polytherapies. Arch Neurol. 2011;68:1275.  https://doi.org/10.1001/archneurol.2011.133. CrossRefPubMedGoogle Scholar
  120. 120.
    Laegreid L, Kyllerman M, Hedner T, Hagberg B, Viggedahl G. Benzodiazepine amplification of valproate teratogenic effects in children of mothers with absence epilepsy. Neuropediatrics. 1993;24:88–92.  https://doi.org/10.1055/s-2008-1071520.CrossRefPubMedGoogle Scholar
  121. 121.
    Uguz F. Breastfed infants exposed to combined antipsychotics. Am J Ther. 2016;23:e1962–4.  https://doi.org/10.1097/MJT.0000000000000376.CrossRefPubMedGoogle Scholar
  122. 122.
    Anderson EL, Reti IM. ECT in pregnancy: a review of the literature from 1941 to 2007. Psychosom Med. 2009;71:235–42.  https://doi.org/10.1097/PSY.0b013e318190d7ca.CrossRefPubMedGoogle Scholar
  123. 123.
    Pompili M, Dominici G, Giordano G, Longo L, Serafini G, Lester D, et al. Electroconvulsive treatment during pregnancy: a systematic review. Expert Rev Neurother. 2014;14:1377–90.  https://doi.org/10.1586/14737175.2014.972373.CrossRefPubMedGoogle Scholar
  124. 124.
    Saatcioglu O, Tomruk NB. The use of electroconvulsive therapy in pregnancy: a review. Isr J Psychiatry Relat Sci. 2011;48 https://search.proquest.com/openview/06d784e4e6d0f9b8e7843721a4330168/1?pq-origsite=gscholar&cbl=47717. Accessed 9 Feb 2018.

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityClevelandUSA
  2. 2.Department of Psychiatry, Cleveland ClinicNeurological InstituteClevelandUSA

Personalised recommendations