title: The effects of gestational use of antidepressants and antipsychotics on neonatal outcomes for women with severe mental illness.
abstract: BACKGROUND
  Psychotropic medication use occurs in 8% of pregnancies, with rates increasing, and often multiple medications prescribed.
  
  
  OBJECTIVE
  This study aims to determine if the use of psychotropic medication, in a cohort of women with severe mental illness, increases rates of special care nursery admission and reports differences between antidepressant and antipsychotic medication use either alone or in combination.
  
  
  METHODS
  A retrospective database analysis from a cohort with severe mental illness in pregnancy identified 268 pregnant women who were grouped according to medication type. Demographic, obstetric and neonatal variables were analysed using t-tests, χ2, analysis of variance and logistic regression analysis for special care nursery admission.
  
  
  RESULTS
  The medication groups consisted of: women taking no psychotropic medications (n = 67); those taking antipsychotics (n = 87); those taking antidepressants (n = 55); those taking and a combination of antidepressants/antipsychotics (n = 59). Rates of special care nursery admission in women who took psychotropic medication (41.3%) were elevated compared to those who did not (26.9%) (P = 0.035), and were significantly raised when compared to the general population (P < 0.000). No significant difference occurred between the medication groups. A significant adjusted odds ratio of 2.79 (95% CI 1.286-6.049) was found for special care nursery and psychiatric admission during pregnancy but not for psychotropic medication.
  
  
  CONCLUSIONS
  Rates of special care nursery admission are elevated in neonates of women with severe mental illness taking psychotropic medication, but were not different for monotherapy or polytherapy when prescribing antidepressants or antipsychotic medication. Additional vulnerability occurs in the neonates of women with a mental illness and paediatric presence at delivery is recommended.
authors.affiliation: Department of Obstetrics and Gynaecology, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.|School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Frayne
authors.affiliation: School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western Australia, Australia.|Peel and Rockingham Kwinana Mental Health Services, Rockingham, Western Australia, Australia.
authors.forename: Thinh
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Kellie
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Department of Obstetrics and Gynaecology, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
authors.forename: Suzanna
authors.initials: S
authors.lastname: Allen
authors.affiliation: Department of Nursing and Midwifery Education, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.|School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Hauck
authors.affiliation: School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Helena
authors.initials: H
authors.lastname: Liira
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001034:Apgar Score; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000188:drug therapy*; D010343:Patient Admission / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy; D012151:Resuscitation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents
keywords: antidepressant; antipsychotic medication; neonatal outcomes; pregnancy; special care nursery