Kulkarni Jayashri, De Chellis Adam, Gilbert Heather, Gavrilidis Emmy, Mu Eveline, Karimi Leila, Li Qi
HER Centre Australia, Department of Psychiatry, School of Translational Medicine, Monash University, Melbourne, Australia.
Schizophr Bull. 2024 Jul 20. doi: 10.1093/schbul/sbae132.
Pregnant women with persistent schizophrenia and related disorders may require ongoing antipsychotic treatment, including clozapine. However, the potential risks of using clozapine during pregnancy and the postnatal period remain uncertain.
We conducted a nested case-control study using the National Register of Antipsychotic Medication in Pregnancy (NRAMP) database. Our study assessed pregnancy outcomes among Australian women diagnosed with schizophrenia spectrum disorder and treated with clozapine (n = 14) during the first trimester. These women were compared to 2 subgroups: those treated with quetiapine (n = 53) and those not taking any medication (n = 24) during pregnancy.
We observed higher rates of miscarriage in the clozapine group compared to the quetiapine and drug-free groups. The clozapine group had a higher early pregnancy body mass index but lower overall pregnancy weight gain than the other groups. The prevalence of gestational diabetes was significantly higher in the clozapine group. The percentage of vaginal delivery was higher in the clozapine group than in the other 2 groups. Neonatal outcomes such as gestational age, and Apgar scores were similar across groups. The birth weight was lower in the clozapine group compared to the other 2 groups.
This study suggests that pregnant women taking clozapine and their babies have greater adverse outcomes compared to other groups. Clozapine appears to be associated with a greater risk of miscarriages, maternal gestational diabetes, and lower birth weight. However, the gestational age, Apgar scores, and admission to NICU/SCN were comparable between all groups.
患有持续性精神分裂症及相关障碍的孕妇可能需要持续进行抗精神病药物治疗，包括使用氯氮平。然而，在孕期及产后使用氯氮平的潜在风险仍不明确。
我们利用澳大利亚孕期抗精神病药物登记数据库（NRAMP）进行了一项巢式病例对照研究。我们的研究评估了在孕早期被诊断为精神分裂症谱系障碍并接受氯氮平治疗（n = 14）的澳大利亚女性的妊娠结局。将这些女性与两个亚组进行比较：孕期接受喹硫平治疗的女性（n = 53）和孕期未服用任何药物的女性（n = 24）。
我们观察到，与喹硫平组和未用药组相比，氯氮平组的流产率更高。氯氮平组孕早期的体重指数较高，但总体孕期体重增加低于其他组。氯氮平组的妊娠期糖尿病患病率显著更高。氯氮平组的阴道分娩百分比高于其他两组。各亚组间的新生儿结局，如胎龄和阿氏评分相似。与其他两组相比，氯氮平组的出生体重更低。
本研究表明，与其他组相比，服用氯氮平的孕妇及其婴儿有更多不良结局。氯氮平似乎与流产、母体妊娠期糖尿病及低出生体重的风险增加有关。然而，所有组间的胎龄、阿氏评分及入住新生儿重症监护病房/特殊护理病房的情况相当。
