title: Prenatal antipsychotic exposure and neuromotor performance during infancy.
abstract: BACKGROUND
  Despite the expanding clinical utility of antipsychotics beyond psychotic disorders to include depressive, bipolar, and anxiety disorders, reproductive safety data regarding the neurodevelopmental sequelae of fetal antipsychotic exposure are scarce.
  
  
  OBJECTIVE
  To examine whether intrauterine antipsychotic exposure is associated with deficits in neuromotor performance and habituation in 6-month-old infants.
  
  
  METHODS
  A prospective controlled study was conducted from December 1999 through June 2008 at the Infant Development Laboratory of the Emory Psychological Center examining maternal-infant dyads (N=309) at 6 months postpartum with pregnancy exposure to antipsychotics (n=22), antidepressants (n=202), or no psychotropic agents (n=85). Examiners masked to maternal-infant exposure status administered a standardized neuromotor examination (Infant Neurological International Battery [INFANIB]) that tests posture, tone, reflexes, and motor skills and a visual habituation paradigm using a neutral female face.
  
  
  METHODS
  The INFANIB composite score; number of trials required to achieve a 50% decrease in infant fixation during a visual habituation task; and mean time looking at the stimulus across 10 trials.
  
  
  RESULTS
  Infants prenatally exposed to antipsychotics (mean=64.71) showed significantly lower INFANIB scores than those with antidepressant (mean=68.57) or no psychotropic (mean=71.19) exposure, after controlling for significant covariates (F(2,281)=4.51; P=.01; partial η(2)=0.033). The INFANIB scores were also significantly associated with maternal psychiatric history, including depression, psychosis, and overall severity/chronicity (P's.05) and maternal depression during pregnancy was associated with less efficient habituation (r(245)=0.16; P.02). There were no significant differences regarding habituation between medication exposure groups.
  
  
  CONCLUSIONS
  Among 6-month-old infants, a history of intrauterine antipsychotic exposure, compared with antidepressant or no psychotropic exposure, was associated with significantly lower scores on a standard test of neuromotor performance, highlighting the need for further scrutiny of the reproductive safety and neurodevelopmental sequelae of fetal antipsychotic exposure. Disentangling medication effects from maternal illness effects, which also contributed, remains a critical challenge.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia, USA. kcederb@emory.edu
authors.forename: Katrina C
authors.initials: KC
authors.lastname: Johnson
authors.forename: Jamie L
authors.initials: JL
authors.lastname: LaPrairie
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Brennan
authors.forename: Zachary N
authors.initials: ZN
authors.lastname: Stowe
authors.forename: D Jeffrey
authors.initials: DJ
authors.lastname: Newport
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D002657:Child Development / Q000187:drug effects*; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006185:Habituation, Psychophysiologic / Q000187:drug effects*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D018811:Maternal Exposure; D009483:Neuropsychological Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy*; D011297:Prenatal Exposure Delayed Effects / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D011597:Psychomotor Performance / Q000187:drug effects*; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy*; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D018570:Risk Assessment
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D011619:Psychotropic Drugs