Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-11T04:44:17.376Z Has data issue: false hasContentIssue false
  • English
  • Français

Use of antipsychotic drugs and mood stabilizers in women of childbearing age with schizophrenia and bipolar disorder: epidemiological survey

Published online by Cambridge University Press:  01 February 2013

C. Barbui ,
V. Conti ,
M. Purgato ,
A. Cipriani ,
I. Fortino ,
A. L. Rivolta  and
A. Lora
C. Barbui*
Affiliation:
Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
V. Conti
Affiliation:
Regional Centre for Pharmacovigilance, Lombardy Region, Milano, Italy
M. Purgato
Affiliation:
Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
A. Cipriani
Affiliation:
Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
I. Fortino
Affiliation:
Operative Unit of Territorial Health Services, Lombardy Region, Milano, Italy
A. L. Rivolta
Affiliation:
Regional Centre for Pharmacovigilance, Lombardy Region, Milano, Italy
A. Lora
Affiliation:
Department of Psychiatry, Azienda Ospedaliera Della Provincia di Lecco, Lecco, Italy
*
*Address for correspondence: Professor C. Barbui, Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Policlinico GB Rossi, Piazzale Scuro 10, 37134 Verona, Italy. (Email: corrado.barbui@univr.it)
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims.

To determine the prevalence of women of childbearing age with schizophrenia and bipolar disorder exposed to antipsychotic (AP) drugs and mood stabilizers (MS) in Lombardy, a European region of 10 million inhabitants and 1 752 285 women of childbearing age.

Methods.

The data concerning psychiatric care, drug treatments and pregnancy outcomes were retrieved from local administrative databases during a 12-month census period.

Results.

During a 12-month census period, 2893 women of childbearing age with schizophrenia (74.8% of all women of childbearing age with schizophrenia) and 918 with bipolar disorder (80.1% of all women of childbearing age with bipolar disorder) were exposed to AP drugs or MS, yielding a prevalence of exposure for women with schizophrenia of 1.65 (95% confidence interval (CI) 1.59–1.71) per 1000 female inhabitants, and for women with bipolar disorder of 0.52 (95% CI 0.49–0.55) per 1000 female inhabitants. Persistent exposure to potentially teratogenic medications accounted for one in every 1000 women of childbearing age. Of the 57 pregnancies in women with schizophrenia, normal delivery was recorded in 23 (40%) cases; of the 26 pregnancies in women with bipolar disorder, normal delivery was recorded in 10 (38%) cases.

Conclusions.

In women of childbearing age with severe mental disorders, exposure to psychotropic drugs is substantial, which suggests that the issue of reproductive health is epidemiologically relevant and a major public health concern.

Keywords

bipolar disorderchildbearing agepsychotropic drugsschizophrenia
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 22 , Issue 4 , December 2013 , pp. 355 - 361
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andrade, SE, Kahler, KH, Frech, F, Chan, KA (2006). Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiology and Drug Safety 15, 565–574.Google Scholar
Barbui, C, Cipriani, A (2011 a). Cluster randomized trials. Epidemiology and Psychiatric Sciences 20, 307–309.Google Scholar
Barbui, C, Cipriani, A (2011 b). What are evidence-based treatment recommendations? Epidemiology and Psychiatric Sciences 20, 29–31.Google Scholar
Beynon, S, Soares-Weiser, K, Woolacott, N, Duffy, S, Geddes, JR (2009). Pharmacological interventions for the prevention of relapse in bipolar disorder: a systematic review of controlled trials. Journal of Psychopharmacology 23, 574–591.Google Scholar
Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases 40, 373–383.Google Scholar
Conti, V, Lora, A, Cipriani, A, Fortino, I, Merlino, L, Barbui, C (2012). Persistence with pharmacological treatment in the specialist mental healthcare of patients with severe mental disorders. European Journal of Clinical Pharmacology 68, 1647–1655.Google Scholar
Corrao, G, Cesana, G, Merlino, L (2008). Pharmacoepidemiological research and the linking of electronic healthcare databases available in the Italian region of Lombardy. Biomedical Statistics and Clinical Epidemiology 2, 117–125.Google Scholar
Einarson, A, Boskovic, R (2009). Use and safety of antipsychotic drugs during pregnancy. Journal of Psychiatric Practice 15, 183–192.Google Scholar
Eurostat (2007). European Regional and Urban Statistics Reference Guide. European Communities: Luxemburg.Google Scholar
Gentile, S (2004). Clinical utilization of atypical antipsychotics in pregnancy and lactation. Annals of Pharmacotherapy 38, 1265–1271.CrossRefGoogle ScholarPubMed
Gentile, S (2010). Antipsychotic therapy during early and late pregnancy. A systematic review. Schizophrenia Bulletin 36, 518–544.Google Scholar
Jentink, J, Loane, M, Dolk, H, Barisic, I, Garne, E, Morris, J, de Jong-van der Berg, L (2010). Valproic acid monotherapy in pregnancy and major congenital malformations. New England Journal of Medicine 362, 2185–2193.Google Scholar
Jones, G (2003). Prescribing and taking medicines. British Medical Journal 327, 819.Google Scholar
Leucht, S, Tardy, M, Komossa, K, Heres, S, Kissling, W, Salanti, G, Davis, JM (2012). Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. Lancet 379, 2063–2071.Google Scholar
Lora, A (2009). An overview of the mental health system in Italy. Annali dell'Istituto Superiore di Sanita 45, 5–16.Google Scholar
Lora, A, Barbato, A, Cerati, G, Erlicher, A, Percudani, M (2012). The mental health system in Lombardy, Italy: access to services and patterns of care. Social Psychiatry and Psychiatric Epidemiology 47, 447–454.Google Scholar
Lora, A, Conti, V, Leoni, O, Rivolta, AL (2011). Adequacy of treatment for patients with schizophrenia spectrum disorders and affective disorders in Lombardy, Italy. Psychiatric Services 62, 1079–1084.Google Scholar
Meador, K, Baker, G, Finnell, R (2006). In utero antiepileptic drug exposure: fetal death and malformations. Neurology 67, 407–412.Google Scholar
Muller-Oerlinghausen, B, Berghofer, A, Bauer, M (2002). Bipolar disorder. Lancet 359, 241–247.Google Scholar
National Institute for Health and Clinical Excellence (2007). Antenatal and Postnatal Mental Health. NICE: Great Britain.Google Scholar
Schwarz, EB, Longo, LS, Zhao, X, Stone, RA, Cunningham, F, Good, CB (2010). Provision of potentially teratogenic medications to female veterans of childbearing age. Medical Care 48, 834–842.Google Scholar
Soares-Weiser, K, Bravo, VY, Beynon, S, Dunn, G, Barbieri, M, Duffy, S, Geddes, J, Gilbody, S, Palmer, S, Woolacott, N (2007). A systematic review and economic model of the clinical effectiveness and cost-effectiveness of interventions for preventing relapse in people with bipolar disorder. Health Technology Assessment 11, iii–206.Google Scholar
Sytema, S, Micciolo, R, Tansella, M (1997). Continuity of care for patients with schizophrenia and related disorders: a comparative south-Verona and Groningen case-register study. Psychological Medicine 27, 1355–1362.Google Scholar
Tansella, M, De Salvia, D, Williams, P (1987). The Italian psychiatric reform: some quantitative evidence. Social Psychiatry 22, 37–48.Google Scholar
Tansella, M, Amaddeo, F, Burti, L, Lasalvia, A, Ruggeri, M (2006). Evaluating a community-based mental health service focusing on severe mental illness. The Verona experience. Acta Psychiatrica Scandinavica, Supplement 429, 90–94.Google Scholar
van Os, J, Kapur, S (2009). Schizophrenia. Lancet 374, 635–645.Google Scholar
WHO Collaborating Centre for Drug Statistic Methodology (2003). Guidelines for ATC Classification and DDD Assignment. WHO: Oslo.Google Scholar
World Health Organization (1992). Manual of the International Classification of Diseases, Injuries, and Causes of Death. World Health Organization: Geneva.Google Scholar