In the course of daily treatment, we are often asked whether psychiatric patients can get married or become pregnant, and if so, what effect the drugs have on the child. It is not scientific to answer yes or no to these types of questions. Generally speaking, the effects of psychiatric patients on their offspring can be divided into two types.
Genetic factors.
The percentage of people with schizophrenia in general is 0.14-0.46%. The prevalence of schizophrenia in siblings is 7-15%; in one parent, the prevalence is 15-16%; in both parents, the prevalence is 40-60%. Monozygotic twins: 45-46%, dizygotic twins: 18-37%.
Bipolar disorder has a prevalence of about 0.4% in the general population, 25% in children of one parent, and 50-75% in children of both parents. Monozygotic twins: 66.8% on average, dizygotic twins: 15.6% on average. Mental illnesses are hereditary, and children with genetic influences do not always develop them; we cannot ignore environmental and social factors.
Drug effects.
Current information on the reproductive safety of drugs is overwhelmingly based on case reports, with less information from systematic studies. Existing studies have focused on the observation of recent effects in newborns, with varying results. It is difficult to establish a safe dosing range for any drug at this time. The U.S. Food and Drug Administration (FDA) reports drug hazards to the fetus classifying drugs during pregnancy into the following 5 classes.
Class A: No indication of fetal harm from the drug has been seen in women in the first 3 months of pregnancy (and there is no evidence of harm in the subsequent 6 months, either). These drugs have been shown to have no adverse effects on the fetus and are the safest class.
Class B: for animal experiments and in humans has not been proven to be harmful to the fetus, animal experiments indicate no harm to fetal animals, but there is no adequate research on humans reported, is relatively safe, basically harmless (such as most antidepressants)
Class C: There is no adequate research on animals and people; or there are adverse effects on animals, fetuses and animals, but there is no observation report on humans. This class of drugs is the most difficult to choose clinically. Weighing the benefits for pregnant women outweigh the harm to the fetus available, including most antipsychotic drugs (olanzapine, fenadine, quetiapine, risperidone, some antidepressants.
Grade D: There is clear evidence that grade D is an indication of harm to the fetus, but the benefits of treating maternal disease clearly outweigh these harms (absolute benefit, such as phenytoin sodium), including various antiepileptic drugs such as valproate, carbamazepine, Valium, lithium carbonate, etc.
Class X: drugs that have been shown to be harmful to the fetus, are not beneficial to pregnant women when applied to such drugs, and are prohibited for those who may become pregnant during pregnancy.
The following points should be noted for the use of drugs during pregnancy.
1, the use of drugs for drug metabolism has been clearly described.
2. The drug has been proven to be harmless to the animal embryo.
3. The use of drugs should preferably begin after the third or fourth month of pregnancy.
4, the use of drugs should have clear indications, the application of drugs that may have an impact on the fetus, must weigh the pros and cons before administration.
General principles of medication during pregnancy.
Pre-pregnancy
1, a comprehensive weighing of the benefits and risks of drug discontinuation and use. This includes relapse of disease and the effects of medication on pregnancy and the fetus.
2. Pre-conception health promotion and education, analysis of maternal risk factors, and assessment of the impact of drugs on pregnancy.
3.Adjustment and replacement of drugs known to be harmful to the pregnant woman and fetus before conception.
Conception period
1.Avoid the application of psychotropic drugs in the first 3 months of pregnancy as much as possible, this is the period of organ formation, and the choice of drugs should be weighed against the pros and cons.
2. Apply the lowest maintenance dose and carefully monitor for adverse reactions.
3.Avoid the combined application of multiple drugs, multi-drug synergy can be teratogenic.
4. The pharmacokinetics of drugs can change during conception, so attention should be paid to dose adjustment.
5. Discontinuation reactions have been reported in newborns, and the drug is gradually reduced or discontinued before delivery, generally taking 1 week. The use of psychotropic drugs during pregnancy is not absolutely contraindicated, but when using them, weigh the advantages and disadvantages, and under the guidance of a specialist, choose drugs that have less impact on pregnancy as far as possible, and preferably use low doses to closely monitor the clinical status of the fetus.