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[Antipsychotic agents and pregnant women. A case report]
M Handal1, I Matheson, A G Bechensteen
1Institutt for farmakoterapi, Universitetet i Oslo.
Insights
Certain antipsychotics may pose a risk of behavioral teratogenicity, potentially affecting infant neurodevelopment. Caution is advised when prescribing neuroleptics during pregnancy due to possible psychomotor disturbances in newborns.
Area of Science:
- Neuroscience
- Developmental Toxicology
- Pharmacology
Background:
- Drug-induced developmental disturbances extend beyond physical malformations.
- Central nervous system-acting drugs, like dopamine inhibitors, may impact fetal brain development, particularly in late gestation and postpartum periods, as evidenced by animal studies.
Observation:
- A case of a two-week-old infant girl presenting with psychomotor disturbances, including restlessness and high-pitched crying, was observed.
- The infant's mother received four intramuscular injections of perphenazine decanoate (108 mg each) during the second and third trimesters of pregnancy, with the final doses administered three weeks and two days before delivery.
Findings:
- The infant's symptoms were reminiscent of tardive dyskinesia, a neurological disorder.
- While the existing literature on neuroleptics suggests a low risk of major teratogenicity, a potential for behavioral teratogenicity exists.
Implications:
- This case highlights the potential for neuroleptic medications to cause neurodevelopmental issues in infants.
- Increased caution is recommended when prescribing neuroleptics to pregnant individuals.
- Further research into the behavioral teratogenicity of antipsychotics is warranted to ensure fetal safety.
Abstract:
Teratogenic effects of drugs are not limited to visual malformations but also include developmental disturbances. Probably drugs that inhibit nerve signals such as dopamine in the central nervous system can affect the maturing of the foetal brain in the last trimester and in the postpartum period, as shown in animal studies. We have observed an infant girl with psychomotoric disturbances which occurred at the age of two weeks. The mother had received 108 mg perfenazin decanoate intramuscular injections four times during the second and third trimester, the last two times were three weeks and two days before delivery, which was at term. The symptoms resembled tardive dyskinesia. Periodically the baby showed restlessness and uttered high-pitched cries. The literature on neuroleptics indicates no major teratogenic risk, but possible risk of behavioural teratogenicity. We recommend greater caution in connection with prescribing neuroleptics in pregnancy.