Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5238_Библиотеки_им_академика_М_И_Перельмана.pdf
Perinatal
Psychopharmacology
FarukUguz
LauraOrsolini
Editors
SecondEdition
Perinatal Psychopharmacology
Faruk Uguz • Laura Orsolini
Editors
Perinatal
Psychopharmacology
Second Edition
Editors
Faruk Uguz
Medical Faculty of Medicine
Department of Psychiatry
KTO Karatay University
Konya, Turkey
Laura Orsolini
Unit of Clinical Psychiatry, Department
of Experimental and Clinical Medicine
(DIMSC) Faculty of Medicine and Surgery
Polytechnic University of Marche
Ancona, Italy
ISBN 978-3-031-99719-8 ISBN 978-3-031-99720-4 (eBook)
https://doi.org/10.1007/978-3-031-99720-4
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland
AG 2019, 2025
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
If disposing of this product, please recycle the paper.
Contents
Part I Introduction to Perinatal Psychopharmacology
1 Epidemiology of Use of Psychotropic Drugs in Pregnant
and Nursing Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Sura Alwan and Anick Berard
2 Maternal and Infant Pharmacokinetics of Psychotropic
Medications During Pregnancy and Lactation . . . . . . . . . . . . . . . . . . . 21
Nikolaos Kokras, Eleni Poulogiannopoulou, Marinos
G. Sotiropoulos, and Christina Dalla
3 Safety Parameters and Risk Categories Used
for Psychotropic Drugs in Pregnancy and Lactation . . . . . . . . . . . . . . . 45
Yusuf Cem Kaplan, Hilal Erol, and Elif Keskin-Arslan
4 General Approach to Psychopharmacological Treatment
During the Perinatal Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Cesario Bellantuono
5 The Role of Paternal Mental Health During
the Perinatal Period: From Preconception to Postpartum
Giulia Francesconi, Rosa Volgare, Umberto Volpe, and Laura
Orsolini
Part II Safety of Psychotropic Drugs During Pregnancy
and Lactation
6 Antidepressants in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Esra Yazıcı and Özlem Akçay Ciner
7 Antidepressants During Lactation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Pierre Desaunay, Camille Blouet, Mélanie Alexandre,
and Fabian Guénolé
8 Antipsychotics in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Carolyn Breadon and Jayashri Kulkarni
. . . . . . . . . . 79
v
vi
Contents
9 Antipsychotics During Lactation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Adele C. Viguera, Alexia M. Jones, Joshua Niforatos,
and Carrie Swetlik
10 Mood Stabilizers in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Anne-Laure Sutter-Dallay and Florence Gressier
11 Mood Stabilizers During Lactation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Sandeep Grover, Devakshi Dua, and Nidhi Yadav
12 Benzodiazepines and Z-Drugs in Pregnancy . . . . . . . . . . . . . . . . . . . . . 289
Cesario Bellantuono
13 Benzodiazepines and Z-Drugs During Lactation . . . . . . . . . . . . . . . . . . 303
Betül Bakay and Faruk Uguz
14 Miscellaneous Drugs During Pregnancy and Lactation . . . . . . . . . . . . 311
Hasan Bakay
Part III Pharmacological Management of Psychiatric Disorders
During the Perinatal Period
15 Major Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Sonya Rasminsky and Vivien K. Burt
16 Bipolar Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Michael Thomson and Verinder Sharma
17 Schizophrenia and Related Psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Selma Bozkurt
18 Obsessive-Compulsive Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Faruk Uguz
19 Anxiety Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
Benyamin Daniel Daniel, Caterina Dell’Ann, and Carlo Marchesi
20 Posttraumatic Stress Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427
Mine Sahingoz and Serap Sari
21 Alcohol Use Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447
Laura Orsolini, Rosa Volgare, Giulia Francesconi, Giovanni
Martinotti, and Umberto Volpe
22 Substance Use Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467
Laura Orsolini, Giulia Francesconi, Rosa Volgare,
Fabrizio Schifano, and Umberto Volpe
23 Pharmacological Approaches to Managing
Common Sleep Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495
Laura Palagini
24 Psychiatric Aspect and Psychopharmacologic Treatment
of Hyperemesis Gravidarum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535
Goksen Yuksel
Part I
Introduction to Perinatal Psychopharmacology
Epidemiology ofUse ofPsychotropic
Drugs inPregnant andNursing Women
SuraAlwan andAnickBerard
1.1 Introduction
Psychiatric disorders include a wide range of illnesses that are usually chronic and
relapsing during an individual’s lifespan. The most commonly encountered psychiatric disorders include depression, bipolar affective disorder, schizophrenia, obsessive-compulsive disorder, and anxiety disorders. Women of reproductive age are
more likely to develop some of these common conditions (Deierlein etal. 2024) and
can be specically vulnerable when they are affected in the perinatal period, dened
as “including the entire period of pregnancy, the periconception period and up to 12
months postpartum” (Koukopoulos etal. 2020). In the United Kingdom (UK), it is
estimated that about 25% of women aged 20–35years who commit suicide do so in
the perinatal period, and that these women were twice as likely to have been receiving mental healthcare mostly with regard to anxiety and depression illnesses (Kim
and Silver 2016). Another study that reviewed pregnancy-related mental health
deaths, including suicides and accidental overdoses, in the United States (US) indicated 11% of pregnancy-related deaths to be due to mental health conditions and
that three-quarters of people with a pregnancy-related mental health cause of death
had a history of depression; more than two-thirds had past or current substance use
(Trost etal. 2021).
Pregnancy is believed to be neither protective against mental illness nor a specically high-risk period. There appears to be no signicant differences in the prevalence of psychiatric and mood disorders between pregnant and non-pregnant women
1
S. Alwan (*)
Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
e-mail: alwans@bcchr.ca
A. Berard
Faculty of Pharmacy, University of Montreal, and Research Center, CHU Sainte-Justine,
Montreal, QC, Canada
© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2025
F. Uguz, L. Orsolini (eds.), Perinatal Psychopharmacology,
https://doi.org/10.1007/978-3-031-99720-4_1
3
4
S. Alwan and A. Berard
of reproductive age (Mota etal. 2019). Few studies, however, report on the impact
of pregnancy on severe mental and psychiatric conditions (Vigod et al. 2014;
Molenaar etal. 2023). Bipolar disorder has been most studied in this regard, and it
appears that its overall recurrence risk in the perinatal period may exceed 70%
(Alcantarilla etal. 2023; Perry etal. 2021). Furthermore, untreated maternal mental
and psychiatric illness in pregnancy can have negative impacts on both the mother
and the baby by increasing the risk of developing postpartum depression and maternal suicidal thoughts (Hagatulah etal. 2024). When left untreated, these conditions
can also lead to unhealthy lifestyle habits adversely affecting pregnancy outcome,
such as poor nutrition, smoking, alcohol drinking, and substance use (Wohrer etal.
2024), and developing certain conditions, including diabetes and other pregnancy
complications, such as pre-eclampsia (Kozhimannil et al. 2009; Bergink et al.
2015). There is also evidence in the literature that untreated maternal mental illness
itself, including stress and other psychiatric conditions, is associated with various
adverse pregnancy outcomes including spontaneous abortions (Nikfar etal. 2012),
preterm birth, low birth weight, intrauterine growth restriction, and operative delivery (Mohamed etal. 2023; Walsh etal. 2019), as well as long-term neurodevelopmental and health outcomes (Caparros-Gonzalez etal. 2021).
Besides risk of the untreated illnesses, pharmacotherapy of these disorders is
further complicated by concerns over potential risks to the pregnant woman and her
prenatally exposed or breastfeeding infant, including structural and behavioral teratogenicity, neonatal toxicity, and other adverse reproductive outcomes. The absence
of randomized control trials (RCTs) in this eld due to the difculty and ethical
concerns of conducting them during pregnancy results in most safety and/or risk
data being extrapolated from observational studies, which need to be interpreted
carefully because of their specic potential biases. Several qualitative studies across
different geographical regions found that many women were concerned about the
potential adverse effects of psychotropic medications during pregnancy and the
nursing period, often reporting that professional advice was lacking in detail which
affected their decisions (Stevenson etal. 2016; FrayNE et al. 2023; James etal.
2024). Thus, it is essential to maintain clear communication and collaboration
between healthcare providers and patients to facilitate informed decision-making
regarding medication use during the perinatal period.
Fortunately, the availability of online clinical teratology knowledge databases,
such as TERIS (https://terisweb.deohs.washington.edu) and REPROTOX (https://
reprotox.org), has greatly simplied the process of collecting and analyzing the data
from the published literature and translation into proper clinical assessment of
human teratogenic risk. In addition, pharmaceutical labels are now developed in
accordance with the revised US Food and Drug Administration (FDA) Pregnancy
and Lactation Labeling Rule and the European Medicines Agency (EMA), along
with an opportunity for alignment across regions being actively discussed (Kappel
etal. 2023). Furthermore, access to information on the effects of drugs and other
exposures in the perinatal period, via phone, text or online chat, is also provided to
the public through Teratology Information Services (TIS) in the United States
(https://mothertobaby.org), in collaboration with a Canadian platform (https://www.
1 Epidemiology ofUse ofPsychotropic Drugs inPregnant andNursing Women
5
healthypregnancy hub.ca), and in Europe and other parts of the world (https://www.
entis- org.eu/). TIS centers continue to combine multidisciplinary expertise and con-
solidate knowledge from the elds of teratology, dysmorphology, toxicology, pharmacology, epidemiology, clinical genetics, obstetric medicine, infectious disease,
and occupational health. Such a collaborative approach enables these services to
provide timely, evidence-based information to patients and healthcare providers
regarding exposures during pregnancy and breastfeeding (Alwan and Grant 2024).
1.2 Psychopharmacology inPregnant andNursing Women
Management of mental and psychiatric illnesses in the perinatal period is challenging and becomes more difcult when the pregnancy is unplanned, which is the case
in nearly half of pregnancies (UNFPA 2022). Therefore, it is important that healthcare providers discuss pharmacological risks of pregnancy at the time of administration for all women of reproductive age as well as alternative treatment options such
as psychotherapy. Psychotropic medications in the perinatal period are prescribed
for women experiencing moderate to severe psychiatric conditions, whether newly
developed during pregnancy or as a relapse of pre-existing disorders (Payne 2021).
It is estimated that at least 10% of women are prescribed a psychotropic medication
in the perinatal period (Hanley etal. 2020; Robiyanto etal. 2023; Leong etal. 2017;
Bérard etal. 2019), with usage varying by geographical region, over time, and over
the course of a pregnancy, underscoring the importance of continuous monitoring
and evaluation of these agents in the perinatal period to inform guidelines and
ensuring safety of both maternal and fetal health. Prescribed psychotropics can generally fall into ve main classes of medications: antidepressants, anxiolytics, antipsychotics, mood stabilizers, and stimulants. An update on the epidemiology and
patterns of use of these drug classes (and subclasses) will be discussed below.
1.2.1 Antidepressants
Depression affects about 1in 10 women of childbearing age (Guo etal. 2018). The
increasing use of antidepressants over the past two decades, specically with regard
to the selective serotonin reuptake inhibitors (SSRIs), has put these medications
among the most common therapeutic prescriptions worldwide. In the United States,
for example, the National Center for Health Statistics reports that between 2015 and
2018, antidepressants were the rst most commonly prescribed class of medications
among females (17.7%) (Brody and Gu 2020), with the rate continuing to increase
signicantly over the years.
Prevalence of exposure to an antidepressant at some point during pregnancy has
ranged between 2% and 10% (Alwan etal. 2011; Huybrechts etal. 2013; JimenezSolem etal. 2013; Bénard-Laribière etal. 2018; Molenaar etal. 2020; Donald etal.
2021; Bérard etal. 2017b), with the lowest rates being reported in Scandinavian
populations, while the highest observed in the United States. The increase in