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The Use of Olanzapine in Pregnancy and Congenital Cardiac and Musculoskeletal Abnormalities

To The Editor: There are very few reports concerning the risk of olanzapine treatment during pregnancy, and it is not considered contraindicated for use in pregnant women with psychosis. We report a case of a neonate infant born to a 25-year-old primigravida woman treated with olanzapine for schizophrenia throughout her pregnancy.

"Ms. A," a 25-year-old primigravida woman, had not received any prescribed medication other than olanzapine 10 mg daily. She had not been smoking, using drugs, or drinking alcohol during her pregnancy. There was no family history of birth defects; no viral infections occurred during pregnancy, and no work exposures were present. There was no consanguinity between her and the father of the baby. The baby was born with an atrioventricular canal defect and unilateral clubfoot. No additional phenotypic abnormalities were observed, and the karyotype was found to be 46XY. The baby was treated for the clubfoot with a plaster cast with satisfactory results and at the age of 6 months underwent open heart surgery because of the atrioventricular canal, with full recovery.

Olanzapine was the third atypical antipsychotic to gain approval by the Food and Drug Administration and has become one of the most commonly used atypical antipsychotics. Information regarding the safety of the drug during pregnancy has primarily been based on several case reports of women receiving the drug throughout pregnancy or from the second and third trimester onward. Most of the reports have been favorable, reporting no birth abnormalities (1–5). A prospective clinical trial showed no statistically significant differences in any of the pregnancy outcomes between patients receiving atypical antipsychotics relative to a comparison group. The only significant difference between the groups was higher rates of low-birth-weight babies in the treated group of women (6).

Other case reports in the literature involving treatment with olanzapine throughout pregnancy include a report of a baby born with hip dysplasia (7) as well as reports of a meningocele and ankyloblepharon (8). Association between schizophrenia itself and congenital cardiac anomalies was suggested recently (9) and therefore could be the reason for the atrioventricular canal in our patient’s baby, regardless of the olanzapine treatment. Additional reports would be helpful in clarifying whether our case was incidental or because of a teratogenic effect of olanzapine, and the limitations of a single case report need to be taken into consideration.

Footnotes

Dr. Yeshayahu reports no competing interests.

This letter (doi: 10.1176/appi.ajp.2007.07010176) was accepted for publication in August 2007.

References

1. Littrell KH, Johnson CG, Peabody CD, Hilligoss N: Antipsychotics during pregnancy. Am J Psychiatry 2000; 157:1342[CrossRef][Medline]
2. Mendhekar DN, War L, Sharma JB, Jiloha RC: Olanzapine and pregnancy. Pharmacopsychiatry 2002; 35:122–123[CrossRef][Medline]
3. Kirchheiner J, Berghofer A, Bolk-Weischedel D: Healthy outcome under olanzapine treatment in a pregnant woman. Pharmacopsychiatry 2000; 33:78–80[CrossRef][Medline]
4. Neumann NU, Frasch K: Olanzapine and pregnancy: 2 case reports. Nervenarzt 2001; 72:876–878[CrossRef][Medline]
5. Nagy A, Tenyi T, Lenard K, Herold R, Wilhelm F, Trixler M: Olanzapine and pregnancy. Orv Hetil 2001; 142:137–138[Medline]
6. McKenna K, Koren G, Tetelbaum M, Wilton L, Shakir S, Diav-Citrin O, Levinson A, Zipursky RB, Einarson A: Pregnancy outcome of women using atypical antipsychotic drugs: a prospective comparative study. J Clin Psychiatry 2005; 66:444–449[Medline]
7. Spyropoulou AC, Zervas IM, Soldatos CR: Hip dysplasia following a case of olanzapine exposed pregnancy: a questionable association. Arch Womens Ment Health 2006; 9:219–222; Epub 2006 Jun 8[CrossRef][Medline]
8. Arora M, Praharaj SK: Meningocele and ankyloblepharon following in utero exposure to olanzapine. Eur Psychiatr; 2006; 21:345–356. Epub2006 Mar 20
9. Jablensky AV, Morgan V, Zubrick SR, Bower C, Yellachich LA: Pregnancy, delivery, and neonatal complications in a population cohort of women with schizophrenia and major affective disorders. Am J Psychiatry 2005; 162:79–91[Abstract/Free Full Text]

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