Iqbal Mohammad Masud, Aneja Alka, Rahman Atiq, Megna James, Freemont Wanda, Shiplo Mohammed, Nihilani Nikil, Lee Kathy
Dr. Iqbal is Clinical Director, Central New York Psychiatric Center, Auburn Satellite Mental Health Unit, New York, Clinical Assistant Professor, Department of Psychiatry at SUNY Upstate Medical University, Syracuse, New York.
Psychiatry (Edgmont). 2005 Aug;2(8):36-44.
Chlorpromazine, haloperidol, fluphenazine, clozapine, risperidone, quetiapine, olanzapine, ziprasidone, and aripiprazole are antipsychotics commonly used in psychiatric medicine. Approximately one third of pregnant women with psychotic symptoms use antipsychotics at least once. This review will discuss the effects of antipsychotic use during pregnancy and lactation on the fetus and infant.Although adequate and well-controlled studies have not been done in any one of these antipsychotic drugs, animal studies have revealed evidence of teratogenic or embryo/fetotoxic effects in all of them. Toxicities include skeletal malformations, central nervous system (CNS) defects, cleft palate, cardiac abnormalities, decreased fetal growth, and fetal death. For example, in pregnant women, congenital malformations and perinatal death have been reported with chlorpromazine use. Both chlorpromazine and fluphenazine in monotherapy have been shown to cause extrapyramidal symptoms and respiratory distress in infants born to mothers treated with these medications. Haloperidol use during pregnancy has been linked to severe limb reduction defects.Effects of antipsychotic use in lactating mothers are mostly unknown. However, the use of chlorpromazine has been reported to result in drowsiness and lethargy in breastfed infants. Additionally, clozapine has been reported to cause sedation, decreased suckling, restlessness, irritability, seizures, and cardiovascular instability of infants were also reported with clozapine use in lactating mother. Use of antipsychotic drugs by pregnant and lactating mother may only be justified if the potential benefit outweighs the potential risk to the fetus.
氯丙嗪、氟哌啶醇、氟奋乃静、氯氮平、利培酮、喹硫平、奥氮平、齐拉西酮和阿立哌唑是精神病医学中常用的抗精神病药物。约三分之一有精神病症状的孕妇至少使用过一次抗精神病药物。本综述将讨论孕期和哺乳期使用抗精神病药物对胎儿和婴儿的影响。尽管尚未对这些抗精神病药物中的任何一种进行充分且严格对照的研究，但动物研究已显示它们均有致畸或胚胎/胎儿毒性作用的证据。毒性包括骨骼畸形、中枢神经系统（CNS）缺陷、腭裂、心脏异常、胎儿生长发育迟缓及胎儿死亡。例如，有报道称孕妇使用氯丙嗪会出现先天性畸形和围产期死亡。氯丙嗪和氟奋乃静单药治疗均已显示会导致接受这些药物治疗的母亲所生婴儿出现锥体外系症状和呼吸窘迫。孕期使用氟哌啶醇与严重的肢体减少缺陷有关。哺乳期母亲使用抗精神病药物的影响大多未知。然而，有报道称使用氯丙嗪会导致母乳喂养的婴儿出现嗜睡和无精打采。此外，有报道称氯氮平会引起婴儿镇静、吸吮减少、烦躁不安、易激惹、癫痫发作，哺乳期母亲使用氯氮平还会导致婴儿出现心血管不稳定。只有当潜在益处超过对胎儿的潜在风险时，孕妇和哺乳期母亲使用抗精神病药物才可能是合理的。
