Seroquel and pregnancy

[Andreia]

Hi.
Im new on this group. I am from Portugal (sorry for any mistakes; english is not my native language).

I am on Seroquel sr 50 mg for sleep and sporadic anxiety ( in crises, i take150 mg and valium 10mg SOS). I feel that i am psychologically dependent of this med. I would like to try to get pregnant but iam finding very hard to wean of seroquel. Is this dose safe to take during pregnancy? Should i try to stop in the first trimester at least? If I can not stop, should I take any specific supplements to avoid damages?

Thank you so much.
Andreia.

[Sandra]

Andreia,

Seroquel (quetiapine) is rated a P3-unknown-risk to fetus cannot be ruled out. No apparent increased risk of congenital anomalies in a small number of studies. (Koren, Tenyi, Taylor, McKenna, Gentile) Risk of maternal weight gain with subsequent increase in diabetes mellitus and thromboembolic events and neonates large for gestational age. (Koren) In a study conducted on the use of atypical antipsychotics during late pregnancy, it was found that Quetiapine had the least amount of passage through the placenta compared to other atypical antipsychotics (i.e. olanzapine,haloperidol, and risperidone).[2] Quetiapine or Seroquel is an atypical antipsychotic drug used in the treatment of schizophrenia and bipolar disorders.[1] It is thought to work by blocking the dopamine and serotonin receptors. In a study conducted on the use of atypical antipsychotics during late pregnancy, it was found that Quetiapine had the least amount of passage through the placenta compared to other atypical antipsychotics (i.e. olanzapine,haloperidol, and risperidone).[2] In a case report published in the Archives of Women?s Mental Health, a 30 year old woman with bipolar disorder who developed a manic episode during her second trimester of pregnancy was followed. She had been on lithium in the past and was now started on Quetiapine. She delivered a healthy full term infant who had normal development at 3 months of age.[3]

1.##Briggs G, Freeman R, Yaffe S. A Reference Guide to Fetal and Neonatal Risk: Drugs in Pregnancy and Lactation. Vol 1. Seventh Edition ed. Philadelphia, PA: Lippincott Williams & Williams; 2005.
2.##Newport DJ, Calamaras MR, DeVane CL, et al. Atypical antipsychotic administration during late pregnancy: placental passage and obstetrical outcomes. Am J Psychiatry. Aug 2007;164(8):1214-1220.
3.##Cabuk D, Sayin A, Derinoz O, Biri A. Quetiapine use for the treatment of manic episode during pregnancy. Arch Womens Ment Health. 2007;10(5):235-236.


Valium (diazepam) is rated a P4-positive evidence of fetal risk. Diazepam does not appear to be a major teratogen but the possibility of a link to cleft lip/palate has been reported in the literature. Due to a possible adverse effect on the neurodevelopment of the exposed fetus, diazepam should not be used during pregnancy unless the benefit to the mother outweighs the risk to the fetus. Neonatal withdrawal syndrome may occur at term. Because the use of these drugs is rarely a matter of urgency, the use of diazepam during the first trimester should be avoided. Increased states of anxiety may also adversely affect pregnancy outcome & this should be considered prior to discontinuing this medication. Buspirone is an alternative class B but may not work as well. Diazepam is a benzodiazepine used in the treatment of anxiety disorders, muscle spasms, and seizure disorders.[1] No apparent increase in the risk of major congenital anomalies has been noted with diazepam use, but there may be a slight association with cleft lip/palate. If given near term, diazepam may cause hypotonia, sucking difficulties, or withdrawal symptoms in the newborn. Infants may also have lower birthweights when exposed to diazepam in utero.[2-8] A study by Laegreid et al reported a possible negative neurodevelopmental effect on infants exposed to in utero benzodiazepines.[9] Benzodiazepines should not be abruptly withdrawn due to the risk of withdrawal symptoms that may be severe.[2] In summary, diazepam does not appear to be a major teratogen but the possibility of a link to cleft lip/palate has been reported in the literature. Due to a possible adverse effect on the neurodevelopment of the exposed fetus, diazepam should not be used during pregnancy unless the benefit to the mother outweighs the risk to the fetus.

1.##Kastrup E. Drug Facts and Comparisons 2010: Wolters Kluwer Health; 2010.
2.##Briggs G, Freeman, R., and Yaffe, S. Drugs in Pregancy and Lactation. Vol Seventh Ed. Philadelphia PA: Lippincott, Williams, and Wilkins; 2005.
3.##Czeizel AE, Szegal BA, Joffe JM, Racz J. The effect of diazepam and promethazine treatment during pregnancy on the somatic development of human offspring. Neurotoxicol Teratol. Mar-Apr 1999;21(2):157-167.
4.##Czeizel AE, Eros E, Rockenbauer M, Sorensen HT, Olsen J. Short-Term Oral Diazepam Treatment during Pregnancy : A Population-Based Teratological Case-Control Study. Clin Drug Investig. 2003;23(7):451-462.
5.##Gidai J, Acs N, Banhidy F, Czeizel AE. A study of the effects of large doses of medazepam used for self-poisoning in 10 pregnant women on fetal development. Toxicol Ind Health. Feb-Mar 2008;24(1-2):61-68.
6.##Koren G. Medication Safety in Pregnancy and Breastfeeding. McGraw-Hill. Accessed June, 23, 2010, 2007.
7.##Ornoy A, Arnon J, Shechtman S, Moerman L, Lukashova I. Is benzodiazepine use during pregnancy really teratogenic? Reprod Toxicol. Sep-Oct 1998;12(5):511-515.
8.##Rosenberg L, Mitchell AA, Parsells JL, Pashayan H, Louik C, Shapiro S. Lack of relation of oral clefts to diazepam use during pregnancy. N Engl J Med. Nov 24 1983;309(21):1282-1285.
9.##Laegreid L, Hagberg G, Lundberg A. Neurodevelopment in late infancy after prenatal exposure to benzodiazepines--a prospective study. Neuropediatrics. Apr 1992;23(2):60-67.


Sandra Lovato R.N.
InfantRisk Center
806-352-2519

[ktp928]

How did your baby do after birth?