PubMed · 12778690
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Teresa Dodd-Butera, Molly Broderick. 2003. Thalidomide makes a comeback.. https://pubmed.ncbi.nlm.nih.gov/12778690/
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BACKGROUND: When a pregnant or lactating woman is treated with an antipsychotic drug, the maternal need of antipsychotics must be weighed against possible risks to the fetus/infant. MATERIAL AND METHODS: Published articles on the use of antipsychotics during pregnancy and lactation were identified by Medline and Embase searches. An overview is presented. RESULTS: Available data do not indicate a clinically significant increased risk of congenital malformations after use of first-generation antipsychotics in pregnancy. However, use in the third trimester increases the risk of extrapyramidal symptoms in the newborn. Epidemiological studies do not indicate long-term effects on psychomotor development or cognitive abilities. For second-generation antipsychotics, data are generally very sparse. The excretion in breast milk of first-generation high potency antipsychotics is generally low and no negative effects have been documented after use in monotherapy. For second-generation antipsychotics, data are sparse or lacking. INTERPRETATION: First-generation antipsychotics do not appear to be teratogenic. If antipsychotics are used in the third trimester, the neonate should be observed for extrapyramidal symptoms. When the use of a first-generation antipsychotic is indicated in a lactating woman, the favourable effects of lactation will most likely in the majority of cases exceed the theoretical risk of detrimental drug effects in the infant. Nevertheless, efforts should always be made to minimise drug exposure to the fetus or suckling infant.
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Most of the attention currently focused on endocrine-active chemicals is directed to their effects on the development of offspring exposed to them in utero or during the neonatal period. Pregnant Crj:CD(SD)IGS rats were given ethinyl estradiol (EE) orally in doses of 0.5-50 microg/kg/day from gestational day 7 to postnatal day 18, and their offspring were examined for its effects. Our previous study according to a similar protocol demonstrated the occurrence of cleft phallus in the female offspring exposed to 50 microg/kg of EE in utero and during the lactation period. The present study was designed to assess (1) the reproducibility of the induction of cleft phallus, (2) the fertility of female rats with cleft phallus, and (3) whether any delayed effects, possibly delayed anovulation, were induced. At 50 microg/kg cleft phallus was observed in almost all of the female offspring, and slight retardation of body weight gain was detected in both sexes. At 15-17 weeks of age the animals with cleft phallus could copulate and had fertility comparable to the control group. At 6 months of age, on the other hand, 6/8 of the female offspring at 50 microg/kg exhibited abnormal cyclicity, including persistent estrus, and histological examination revealed follicular cysts and absence of corpora lutea in the ovaries of the rats with persistent estrus. These findings are consistent with delayed anovulation syndrome. The results suggest that observation of cyclicity at 6 months old is able to detect possible delayed ovarian dysfunction induced by perinatal exposure to chemicals.