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In utero antipsychotic exposure linked to neuromotor impairment

NEW YORK (Reuters Health) – Infants exposed in utero to antipsychotics have significantly lower neuromotor performance scores than other infants, including those exposed in utero to antidepressants, according to new findings.

“The use of atypical antipsychotics has increased dramatically in recent years,” Dr. Katrina C. Johnson from Emory University, Atlanta, Georgia told Reuters Health. “Although preliminary, the results of this study suggest that when clinically prudent, physicians may want to exercise additional caution when weighing the potential risks and benefits of prescribing antipsychotic medication to pregnant women.”

Dr. Johnson and colleagues reported online April 2 in Archives of General Psychiatry on roughly 300 six-month-old infants — 163 male and 146 female – including 22 who were exposed to antipsychotic medications in utero, 202 with exposure to antidepressants, and 85 who had not been exposed to either type of drug.

On the Infant Neurological International Battery (INFANIB), a standardized neuromotor screening instrument, infants in the antipsychotic exposure group had significantly lower scores (mean, 63.86) than those in the antidepressant exposure group (mean, 68.58; p<0.01) or the control group (mean, 70.12; p <0.01). All these averages were in the "transiently abnormal" range (55 to 71 for infants at four to eight months of age).

The INFANIB scores did not differ significantly between infants in the no psychotropic exposure group and infants in the antidepressant exposure group.

Infant outcomes were also negatively associated with indices of maternal psychiatric illness, the researchers note.

In multiple regression analyses, there was a trend toward a treatment duration effect using INFANIB scores and the number of gestational weeks exposed to antipsychotics.

In contrast to the neuromotor performance results, there was no significant effect of prenatal medication exposure group on performance of a habituation task, indicating that these agents may not significantly alter early attention modulation and learning.

“The instrument used in this investigation is a particularly sensitive measure of infant neuromotor function,” Dr. Johnson said. “However, clinical norms have not been established for the INFANIB.”

“These preliminary findings need to be replicated and investigated further using larger, prospective samples and clinically-normed, standardized measures before any conclusions can be drawn with respect to clinical care,” Dr. Johnson concluded. “In addition, the results from this study as well as others suggest that both maternal mental illness and psychotropic medications may influence fetal neurodevelopment. When discussing the risks and benefits with patients, this point should be highlighted.”

SOURCE: http://bit.ly/HWWUCs

Arch Gen Psychiatry 2012.