Systematic Reviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Apr 19, 2024; 14(4): 582-599
Published online Apr 19, 2024. doi: 10.5498/wjp.v14.i4.582
Outcomes of long-acting injectable antipsychotics use in pregnancy: A literature review
Ana V Pejčić, Srdjan M Stefanović, Miloš N Milosavljević, Vladimir S Janjić, Marko M Folić, Nevena D Folić, Jovana Z Milosavljević
Ana V Pejčić, Miloš N Milosavljević, Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, Serbia
Srdjan M Stefanović, Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, Serbia
Srdjan M Stefanović, Marko M Folić, Department of Clinical Pharmacology, University Clinical Center Kragujevac, Kragujevac 34000, Serbia
Vladimir S Janjić, Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, Serbia
Vladimir S Janjić, Clinic for Psychiatry, University Clinical Center Kragujevac, Kragujevac 34000, Serbia
Marko M Folić, Center for Pharmaceutical and Pharmacological Research, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, Serbia
Nevena D Folić, Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, Serbia
Nevena D Folić, Pediatric Clinic, University Clinical Center Kragujevac, Kragujevac 34000, Serbia
Jovana Z Milosavljević, Department of Anatomy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, Serbia
Author contributions: Pejčić AV, Stefanović SM, Milosavljević MN, Janjić VS, Folić MM, Folić ND, and Milosavljević JZ contributed to conception, design, literature search, data analysis, drafting and editing of the manuscript, and approved the final manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ana V Pejčić, PhD, Assistant Professor, Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, Kragujevac 34000, Serbia. anapejcic201502@yahoo.com
Received: December 3, 2023
Peer-review started: December 3, 2023
First decision: January 23, 2024
Revised: February 5, 2024
Accepted: March 6, 2024
Article in press: March 6, 2024
Published online: April 19, 2024
Processing time: 135 Days and 8.3 Hours
Abstract
BACKGROUND

Women with a history of serious psychotic disorders are at increased risk of disease relapse during pregnancy. Long-acting injectable (LAI) antipsychotics have been widely used to improve adherence and prevent relapse in patients with various severe psychotic disorders, but there is a lack of high-quality data from previous research on the safety of LAI antipsychotics during pregnancy.

AIM

To summarize relevant data on maternal, pregnancy, neonatal, and developmental outcomes from published cases of LAI antipsychotic use in pregnancy.

METHODS

A literature search was performed through November 11, 2023, using three online databases: PubMed/MEDLINE, Scopus, and Web of Science. Case reports or case series that reported information about the outcomes of pregnancy in women who used LAI antipsychotics at any point in pregnancy, with available full texts, were included. Descriptive statistics, narrative summation, and tabulation of the extracted data were performed.

RESULTS

A total of 19 publications satisfied the inclusion criteria: 3 case series, 15 case reports, and 1 conference abstract. They reported the outcomes of LAI antipsychotic use in 74 women and 77 pregnancies. The use of second-generation LAI antipsychotics was reported in the majority (n = 47; 61.0%) of pregnancies. First-generation LAI antipsychotics were administered during 30 pregnancies (39.0%). Most of the women (approximately 64%) had either satisfactory control of symptoms or no information about relapse, while approximately 12% of them had developed gestational diabetes mellitus. A minority of cases reported adverse outcomes such as stillbirth, spontaneous abortion, preterm birth, low birth weight, congenital anomalies, and neurological manifestations in newborns. However, there were no reports of negative long-term developmental outcomes.

CONCLUSION

Currently available data seem reassuring, but further well-designed studies are required to properly evaluate the risks and benefits of LAI antipsychotic use during pregnancy.

Keywords: Antipsychotic agents; Long-acting injectable; Pregnancy; Outcome; Review

Core Tip: Considering that the currently available research on the use of long-acting injectable antipsychotics in pregnancy consists only of case reports and series, additional well-designed studies are needed to properly evaluate the risks and benefits of their use during pregnancy. Currently available data seem reassuring, given that most of the women seemed to have satisfactory control of the symptoms and that a minority of the cases reported adverse outcomes, such as stillbirth, spontaneous abortion, preterm birth, low birth weight, congenital anomalies, and neurological manifestations in newborns, while there were no reported negative long-term developmental outcomes.