29 April 2004: Antipsychotic drugs are commonly prescribed to women
suffering from psychotic illnesses during pregnancy and after giving birth.
Researchers have concluded that the use of these drugs poses significant
ethical and clinical problems, because of a lack of good evidence
concerning the possible harms and benefits to mothers and their babies.
Details of the research are published in the new issue of The Cochrane
Library.
An estimated 2% of women aged 16-44 years suffer with non-affective
psychotic illnesses, and at least half of them will choose to have a baby.
These women are commonly treated with antipsychotic drugs throughout
pregnancy and while breastfeeding. Special care is always needed when
taking medicine during pregnancy because of the risks of side effects. In
the case of antipsychotics these side effects could affect both the mother
and her baby, and could result in pregnancy complications, birth defects
and neurobehavioural problems. Practitioners need a clear picture of the
potential harms and benefits associated with these drugs if they are to be
confident in prescribing them.
A team of researchers from the University of Manchester and King's College
London, however, has identified a worrying lack of evidence regarding the
safety of commonly used antipsychotics. Led by Roger Webb of the Centre for
Women’s Mental Health Research, the team conducted a systematic review and,
despite extensive searching of the worldwide medical literature, they found
no good quality evidence as to whether these drugs are harmful to the
mother, the unborn baby, or the breastfeeding infant.
The researchers claim that the reason for this ‘evidence gap’ is clear:
randomised trials to evaluate the intervention during pregnancy would
generally be viewed as being unethical. As a result, practitioners are
forced to base their prescribing practices on habit, opinion and historical
clinical practice rather than on clear evidence that the drugs are safe and
effective.
Based on their findings, the authors of the new Cochrane review conclude
that investigation into the safety of antipsychotics for pregnant women is
urgently required. Mr. Webb says “the continued use of antipsychotic drugs
in these women during pregnancy and lactation without sound evidence raises
serious clinical and ethical concerns”.
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Notes for Editors
1. Webb RT, Howard L, Abel KM. Antipsychotic drugs for non-affective
psychosis during pregnancy and postpartum (Cochrane Review). In: The
Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd.
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