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Review: teratogenicity of first- and second-generation antipsychotics in pregnancy is unclear

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Question

Question

Is it safe to use first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) for severe and persistent psychiatric disorders during pregnancy?

Outcomes

Fetal malformation, pregnancy complications (such as gestational diabetes), poor pregnancy outcome, and perinatal and neonatal complications.

Methods

Design

Systematic review.

Data sources

MEDLINE/PubMed, TOXNET, EMBASE and The Cochrane Library were searched for publications in any language since 1950 up to and including July 2008. Additional references were identified from the reference lists of published articles. Manufacturers of antipsychotics were contacted for unpublished data. A separate search was also conducted to complete the safety profile of each reviewed medication.

Study selection and analysis

Studies were selected by one researcher based on their abstracts (or from full texts if abstracts were unavailable). Studies of any design that reported primary data on the outcome of pregnancies exposed to antipsychotic medications (APs) were analysed.

Main results

The review included data from 110 articles found in the electronic databases, two sets of manufacturer-supplied data and seven sources of information identified by hand searching. Many of the studies were case reports. Second-generation antipsychotics: The SGA with the most information available was olanzapine, which was assessed in …

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