Esin ERDOĞAN, Dursun Hakan DELİBAŞ, Sevilay ÖZCAN, İlker ERDOĞAN, Özen ÖNEN SERTOZ

Şizofreni tanısı olan iki kadında gebelik ve lohusalık dönemi boyunca paliperidon palmitat kullanımının anne ve yeni doğan üzerine etkileri

Şizofrenide uzun etkili antipsikotiklerin kullanımı, tedaviye uyumu ve etkin tedavinin sürdürümünü sağlamada avantaj sağlamaktadır. Paliperidon palmitatın (PP) gebelikte ve lohusalık döneminde kullanımı ile ilgili bilgiler kısıtlıdır. Bu yazıda gebelikleri süresince paliperidon palmitat kullanılan, terminde, sağlıklı, vajinal yolla doğum yapan, sonrasında da lohusalık dönemi dahil PP kullanımına devam eden şizofreni tanılı iki olgu bildirilmiştir. Bebeklerin gelişiminin değerlendirilmesi 2, 6, 12, 18, 24. aylarda yapılan fiziksel, pediatrik muayene ve nörodavranışsal gelişim ölçümlerini kapsamaktadır. Vakalarda, izlem süresince anne ve bebek açısından PP kullanımına bağlı olarak belirlenmiş bir sorun saptanmamıştır. Doğum öncesi ve sonrası sürdürülen izlem ve bakımda anne ve yakınları için (uygun olan eş ve aile) net bir plan gereklidir. Antipsikotiklere maruz kalan fetuslarda konjenital malformasyon bildirilmemiş olmasına karşın ileriki dönemlerde bu çocuklarda nörogelişimsel ve nörodavranışsal sorunların ortaya çıkabileceği akılda tutulmalıdır.

Maternal and newborn outcomes following paliperidone palmitate use during pregnancy and puerperal period in two women with schizophrenia

Use of long-acting antipsychotics in schizophrenia provides advantages in achievement of compliance to treatment and maintenance of treatment. There is limited information on use of Paliperidone Palmitate (PP) during period of pregnancy and puerperality. Here, it was reported that two cases with schizophrenia who used PP during period of pregnancy, at the term, had healthy and vaginal delivery and then continued to use PP for a while including period of puerperium. The assessment of infant development included pediatric and psychiatric examination, physical and neurobehavioral development measurements at 2, 6, 12, 18 and 24 months of age. In our cases, no specific risks for the mothers and their children can be attributed to the use of PP during monitoring period. A clear plan for a woman and her supports (partner and family as appropriate) for postpartum care is essential for ongoing monitoring and care. Although it was not reported that fetus exposed to antipsychotics had congenital malformation; it should be kept in mind that in the future these children can develop neurodevelopmental and neurobehavioral problems.

Keywords:

Schizophrenia, pregnancy; puerperality, infant, paliperidone palmitate,

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1. Miller LJ, Finnerty M. Sexuality, pregnancy, and childrearing among women with schizophreniaspectrum disorders. Psychiatr Serv. 1996;47:502-6.
2. Ucok A, Soygur H. Schizophrenia Treatment Guide Second ed. Ankara: The Psychiatric Association of Turkey. 2010;67.
3. Hoirisch-Clapauch S, Brenner B, Nardi AE. Adverse obstetric and neonatal outcomes in women with mental disorders. Thromb Res. 2015;135:60-3.
4. Kulkarni J, Worsley R, Gilbert H, Gavrilidis E, Van Rheenen TE, Wang W et al. A prospective cohort study of antipsychotic medications in pregnancy: the first 147 pregnancies and 100 one year old babies. PLoS One. 2014;9:94788.
5. Reis M, Källén B. Maternal use of antipsychotics in early pregnancy and delivery outcome. J Clin Psychopharmacol. 2008;28:279-88.
6. McKenna K, Koren G, Tetelbaum M, Wilton L, Shakir S, Diav-Citrin O et al. Pregnancy outcome of women using atypical antipsychotic drugs: a prospective comparative study. J Clin Psychiatry. 2005;66:444–9.
7. Sadowski A, Todorow M, Yazdani Brojeni P, Koren G, Nulman I. Pregnancy outcomes following maternal exposure to second-generation antipsychotics given with other psychotropic drugs: a cohort study. BMJ Open. 2013;3:e003062.
8. Peng M, Gao K, Ding Y, Ou J, Calabrese JR, Wu R, et al. Effects of prenatal exposure to atypical antipsychotics on postnatal development and growth of infants: a case-controlled, prospective study. Psychopharmacol. 2013;228:577-84.
9. Johnson KC, LaPrairie JL, Brennan PA, Stowe ZN, Newport DJ. Prenatal antipsychotic exposure and neuromotor performance during infancy. Arch Gen Psychiatry. 2012;69:787-94.
10. Ozdemir AK, Pak SC, Canan F, Gecici O, Kuloglu M, Gucer MK. Paliperidone palmitate use in pregnancy in a woman with schizophrenia. Arch Womens Ment Health. 2015;18:739-40.
11. Bayley N. Scales of Infant and Toddler Development. Third Edit. San Antonio, Psychological Corporation, 2005.
12. Koren G, Cohn T, Chitayat D, Kapur B, Remington G, Myles Reid D et al. Use of atypical antipsychotics during pregnancy and the risk of neural tube defects in infants. Am J Psychiatry. 2002;159:136.
13. Coppola D, Russo LJ, Kwarta RF, Varughese R, Schmider J. Evaluating the postmarketing experience of risperidone use during pregnancy: pregnancy and neonatal outcomes. Drug Saf. 2007;30:247-64.
14. Einarson A, Boskovic R. Use and safety of antipsychotic drugs during pregnancy. J Psychiatr Pract. 2009;15:183-92.
15. McKenna K, Koren G, Tetelbaum M, Wilton L, Shakir S, Diav-Citrin O et al. Pregnancy outcome of women using atypical antipsychotic drugs: a prospective comparative study. J Clin Psychiatry. 2005;66:444-9.
16. Shao P, Ou J, Peng M, Zhao J, Chen J, Wu R. Effects of clozapine and other atypical antipsychotics on infants development who were exposed to as fetus: a post-hoc analysis. PLoS One. 2015;10:e0123373.
17. Kim SW, Kim KM, Kim JM, Shin IS, Shin HY, Yang SJ et al. Use of long-acting injectable risperidone before and throughout pregnancy in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31:543-5.
18. Neyzi O, Günöz H, Furman A, Bundak R, Gökçay G, Darendeliler F et al. Türk çocuklarında vücut ağırlığı, boy uzunluğu ve vücut kitle indeksi referans değerleri. Çocuk Sağlığı ve Hastalıkları Dergisi. 2008;51:1-14.