Long–term Neurodevelopment outcomes to Prenatal Antipsychotic Medication Exposure: Systemic Review

Abstract

Introduction Peak incidence for many psychiatric disorders occurs in reproductive years. We don’t have FDA-approved drugs or clinical guidelines. The main cause of pharmacological suspension in pregnancy is the lack of knowledge of their effects on the product. Gathering information on this regard becomes crucial so we can avoid relapses or exacerbation Objectives Describe neurodevelopmental effects in children ≥ 6 months exposed to antipsychotics prenatally. Methods PROSPERO-CRD42020170314. Using MeSH terms in 5 databases, without language and time restriction, obtaining n=3932. After review and exclusion n=24 were obtained for qualitative review. (Figure 1). Results Of 20 case reports 4 had more ambivalence results (Table 1). In the cohort studies, exposure may cause short-term delay at 6 months but no significant difference at 12 months (Table 2). Table 2 Study N Antipsychotic Months Conclusion using clinical evaluation Imaz et al. Front. Pharmacol.2018; 9:264 1 RisperdalClozapine 72 Abnormal memory, attention/executive, hyperactivity 1 Clozapine 32 Normal 2 Clozapine 18 Abnormal Normal Burt et al. Am J Psychiatry 2010; 167:892-897 1 Olanzapine 12,18,22,29 18 months Abnormal motor 22 months normal 29 months normal Kirchheiner et al. Pharmacopsych 2000; 33:78-80 1 Olanzapine 7,11 7 months Abnormal motor 11 months Normal Mendhekar et al. J Neuropsychiatry Clin Neurosci 2007; 19:2 1 Clozapine 6 5 years Abnormal language Table 3 Study N Antipsychotic Months Conclusion using clinimetry and clinical evaluation Shao et al. Plos ONE, 2015; 10(4),1-9 63 ClozapineRisperidoneOlanzapineQuetiapine 6,12 BSID-III 6 months Adaptive behavior score lower in clozapine group 12 months No difference Johnson et al. Arch Gen Psychiatry2012; 69(8), 787-794 22 HaloperidolSGA* 6 INFANIB Lower scores with SGA then Haloperidol Peng et al. Psychopharmacology 2013; 228(4), 577-584 76 ClozapineRisperidoneSulpirideOlanzapineQuetiapine 6,12 BSID-III 6 months Lower socio-emotional and adaptive behavior scores 12 months No difference Petersen et al. BMJ 2016; 5(6), 1-9 290 FGA+SGA** 6 More neurodevelopmental disorder that those who didn’t take antipsychotics. Image: Conclusions Most are case reports, hence the importance of collecting this information, not ignoring it due to lack of methodological rigor. The intent is not to conclude that prenatal exposure to antipsychotics doesn’t have long-term neurodevelopmental effects, rather documenting the available evidence contributing to an informed clinical decision. Disclosure of Interest None Declared