The ‘hidden’ and ‘forgotten’ psychiatry: The Perinatal Psychiatry

Titolo Rivista RIVISTA SPERIMENTALE DI FRENIATRIA
Autori/Curatori Laura Orsolini, Domenico De Berardis, Cesario Bellantuono
Anno di pubblicazione 2019 Fascicolo 2019/1
Lingua Inglese Numero pagine 24 P. 35-58 Dimensione file 1895 KB
DOI 10.3280/RSF2019-001003
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In the last decade, there has been a growing amount of evidencebased publications in the field of "perinatal psychiatry", some focusing on the risk of an untreated psychiatric disorder for the mother and fetus or infant, others on the efficacy and safety of the available therapeutic treatments, including the psychopharmacology. Psychopathological conditions are the most common morbidities affecting women during pregnancy and postnatal period. Nowadays, it has been well documented that they may determine detrimental effects on the mother, the gestation and the fetus/infant. So far, no RCT are allowed, for ethical purposes, in the perinatal period, so that only a few well-designed prospective investigations and a few observational studies investigated the safety of psychotropic drugs during pregnancy and breastfeeding. Therefore, the ‘conventional’ clinical recommendation has been, in many cases, to discontinue them, especially during pregnancy, due to the risk of birth defects and neonatal adverse reactions. However, in the last decade, more evidence-based data, including original cohort studies, systematic reviews and meta-analyses, established that several psychotropic drugs can be considered relatively safe in early and late pregnancy as well as during breastfeeding and that not using them for psychiatric illness can be at greater risk for both mother and infant. An individualized and shared risk/benefit analysis is needed when judging use for a drug treatment in the perinatal period as evidence for the risks of such drugs is largely based on observational studies. An evidence-based updated short-review of general principles and recommendations to help clinicians in the use of psychotropic medications during the perinatal period are provided, according to the best recent international guidelines, overviews of the literature and expert opinions in the field of perinatal psychiatry and psychopharmacology.

Negli ultimi decenni, si è assistito ad un crescente interesse nello studio e pubblicazione di articoli scientifici nel campo della ‘psichiatria perinatale’, molti dei quali specificatamente indirizzati alla valutazione ed identificazione degli eventuali rischi per la madre ed il feto/nascituro, connessi ad una patologia psichiatrica non trattata; altri specificatamente rivolti allo studio dell’efficacia e sicurezza dei trattamenti (ivi compresi quelli psicofarmacologici) finora riconosciuti e disponibili per la gestione della patologia psichiatrica durante il periodo perinatale. In generale, le condizioni psicopatologiche sono le principali condizioni riscontrabili in comorbidità nelle donne in gravidanza e/o puerpere. Oggigiorno, è stato ben documentato come tali condizioni morbose di tipo psichiatrico possano determinare gravi e rilevanti effetti sulla salute della donna, del feto e del futuro nascituro. Le problematiche di ordine etico, ovviamente limitano l’avvio di studi sperimentali specificatamente rivolti alle donne in gravidanza e/o durante l’allattamento, e molti dei dati finora disponibili provengono da studi osservazionali e prospettici che specificatamente indagano la sicurezza degli psicofarmaci durante il periodo perinatale. Sebbene l’iniziale raccomandazione generale da parte dei professionisti della salute mentale (e non solo) fosse quella di interrompere (arbitrariamente) ogni psicofarmaco assunto dalla madre durante la gravidanza e/o allattamento e di non intraprendere alcun trattamento psicofarmacologica durante il periodo perinatale (anche se necessario clinicamente), i dati recentemente pubblicati hanno permesso negli ultimi anni di investigare in modo più puntuale (e scientificamente razionale) tutte le strategie terapeutiche durante il periodo perinatale. In generale, si consiglia una analisi individualizzata, sempre condivisa con la coppia genitoriale, del bilancio rischi/benefici del trattamento come anche del non trattamento di una patologia psichiatrica durante il periodo perinatale. Il presente manoscritto presenterà una breve revisione aggiornata delle principali raccomandazioni e principi generali di pratica clinica nell’ambito della patologia psichiatrica perinatale, al fine di consentire una scelta e razionalizzazione, nonché individualizzazione, del trattamento psicofarmacologico di tali condizioni in epoca perinatale.

Keywords:Periodo perinatale; psicofarmacologia; psichiatria perinatale; gravidanza; allattamento; raccomandazioni cliniche.

  1. [1] Marcé LV. Treatise on madness in pregnant women, in women who have recently given birth, and in wet nurses, and medical/legal considerations on this subject. [Traité de la folie des femmes enceintes des nouvelles accouchées et des nourrices et considérations médico-légales qui se rattachent à ce sujet]. Paris: JB Baillière et fils; 1858. p.394.
  2. [2] Beyond Blue. Clinical practice guidelines for depression and related disorders: anxiety, bipolar disorder, and puerperal psychosis in the perinatal period. A Guideline for Primary Care Health Professionals. Melbourne: The National Depression Initiative; 2011. -- http://www.beyondblue.org.au/resources/health-professionals/clinical-practice-guidelines/perinatalclinical-practiceguidelines.
  3. [3] National Institute for Clinical Excellence (NICE). Antenatal and postnatal mental health (CG45); 2007. -- http://www.nice.org.uk/guidance/CG45
  4. [4] Scottish Intercollegiate Guidelines Network (SIGN). Management of perinatal mood disorders. Edinburgh: SIGN; 2012. -- http://www.sign.ac.uk/pdf/sign127.pdf.
  5. [5] Yonkers KA, Wisner KL, Stewart DE, Oberlander TF, Dell DL, Stotland N et al. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. General Hospital Psychiatry 2009; 31:403-13.
  6. [6] O’Hara MW & Wisner KL. Perinatal mental illness: definition, description and aetiology. Best Practice & Research Clinical Obstetrics & Gynaecology 2014; 28: 3-12. 10.1016/j.bpobgyn.2013.09.002.
  7. [7] Vesga-López O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS. Psychiatric disorders in pregnant and postpartum women in the United States. Archives of General Psychiatry 2008; 65: 805-15.
  8. [8] Huizink AC, Menting B, Oosterman M, Verhage ML, Kunseler FC, Schuengel C. The interrelationship between pregnancy-specific anxiety and general anxiety across pregnancy: a longitudinal study. Journal of Psychosomatic Obstetrics & Gynaecology 2014; 35: 92-100. DOI: 10.3109/0167482X.2014.944498
  9. [9] Austin MP, Tully L, Parker G. Examining the relationship between antenatal anxiety and postnatal depression. Journal of Affective Disorders 2007; 101: 169-74.
  10. [10] Heron J, O’Connor TG, Evans J, Golding J, Glover V, ALSPAC Study Team. The course of anxiety and depression through pregnancy and the postpartum in a community sample. Journal of Affective Disorders 2004; 80: 65-73.
  11. [11] Borri C., Mauri M., Oppo A., Banti S, Rambelli C, Ramacciotti D, et al. Axis I psychopathology and functional impairment at the third month of pregnancy: results from the Perinatal Depression-Research and Screening Unit (PND-ReScU) study. Journal of Clinical Psychiatry 2008; 69(10): 1617-24.
  12. [12] World Health Organization (WHO). Closing the gap in a generation: health equity through action on the social determinants of health: final report of the Commission on Social Determinants of Health. World Health Organization: Geneva; 2008.
  13. [13] Fisher J, Cabral De Mello M, Patel V, Rahman A, Tran T, Holton S et al. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bulletin of World Health Organization 2012; 90: 139G-149G.. DOI: 10.2471/BLT.11.091850
  14. [14] Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstetrics & Gynaecology 2004; 103: 698-709.
  15. [15] Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstetrics & Gynaecology 2005; 106: 1071-1083.
  16. [16] Goodman JH, Chenausky KL, Freeman MP. Anxiety disorders during pregnancy: a systematic review. Journal of Clinical Psychiatry 2014; 75: 1153-84.
  17. [17] Marchesi C, Ossola P, Amerio A, Daniel BD, Tonna M, De Panfilis C. Clinical management of perinatal anxiety disorders: A systematic review. Journal of Affective Disorders 2016; 190: 543-550.
  18. [18] Dennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. British Journal of Psychiatry 2017; 210: 315-323.
  19. [19] Adewuya AO, Ola BA, Aloba OO, Mapayi BM. Anxiety disorders among Nigerian women in late pregnancy: a controlled study. Archives of Women’s Mental Health 2006; 9: 325-8.
  20. [20] Guler O, Sahin FK, Emul HM, Ozbulut O, Gecici O, Uguz F, et al. The prevalence of panic disorder in pregnant women during the third trimester of pregnancy. Comprehensive Psychiatry 2008; 49: 154-8.
  21. [21] Bar-Shai M, Gott D, Kreinin I, Marmor S. Atypical presentations of pregnancy-specific generalized anxiety disorders in women without a previous psychiatric background. Psychosomatics 2015; 56: 286-91.
  22. [22] Fairbrother N, Young AH, Zhang A, Janssen P, Antony MM. The prevalence and incidence of perinatal anxiety disorders among women experiencing a medically complicated pregnancy. Archives of Women’s Mental Health 2017; 20: 311-319.
  23. [23] Wisner KL, Sit DKY, McShea MC, Rizzo DM, Zorethic RA, Hughes CL. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 2013; 70: 490–8.
  24. [24] Winkel S, Einsle F, Pieper L, Höfler M, Wittchen HU, Martini J. Associations of anxiety disorders, depressive disorders and body weight with hypertension during pregnancy. Archives of Women’s Mental Health 2015; 18: 473-83.
  25. [25] Rubertsson C, Hellström J, Cross M, Sydsjö G.. Anxiety in early pregnancy: prevalence and contributing factors. Archives of Women’s Mental Health 2014; 17: 221-8.
  26. [26] Farias DR, Pinto Tde J, Teofilo MM, Vilela AA, Vaz Jdos S, Nardi AE et al. Prevalence of psychiatric disorders in the first trimester of pregnancy and factors associated with current suicide risk. Psychiatry Research 2013; 210 (30): 962-8.
  27. [27] George A, Luz RF, De Tychey C, Thilly N, Spitz E. Anxiety symptoms and coping strategies in the perinatal period. BMC Pregnancy Childbirth 2013; 13: 233. DOI: 10.1186/1471-2393-13-233
  28. [28] Arch JJ. Pregnancy-specific anxiety: which women are highest and what are the alcohol-related risks? Comprehensive Psychiatry 2013; 54: 217-28.
  29. [29] Sanchez SE, Puente GC, Atencio G, Qiu C, Yanez D, Gelaye B, et al. Risk of spontaneous preterm birth in relation to maternal depressive, anxiety, and stress symptoms. Journal of Reproductive Medicine 2013; 58: 25-33. PMID: 23447915.
  30. [30] Uguz F, Sonmez EO, Sahingoz M, Gokmen Z, Basaran M, Gezginc K, et al. Maternal generalized anxiety disorder during pregnancy and fetal brain development: a comparative study on cord blood brain-derived neurotrophic factor levels. Journal of Psychosomatic Research 2013; 75: 346-50.
  31. [31] Teixeira JM, Fisk NM, Glover V. Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. British Medical Journal 1999; 318: 153-7. PMID: 9888905.
  32. [32] Glover V. Maternal stress or anxiety during pregnancy and the development of the baby. Practice Midwife 1999; 2: 20-22. PMID: 12024606.
  33. [33] Martini J, Knappe S, Beesdo-Baum K, Lieb R, Wittchen HU. Anxiety disorders before birth and self-perceived distress during pregnancy: associations with maternal depression and obstetric, neonatal and early childhood outcomes. Early Human Development 2010; 86: 305-10.
  34. [34] National Institute for Health and Care Excellence. Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance. NICE Clinical Guideline 192; 2014.
  35. [35] Meltzer-Brody S. New insights into perinatal depression: pathogenesis and treatment during pregnancy and postpartum. Dialogues in Clinical Neuroscience 2011;13: 89-100. PMID: 21485749.
  36. [36] Andrisano C, Chiesa A, Serretti A. Newer antidepressants and panic disorder: a meta-analysis. International Clinical Psychopharmacology 2013; 28: 33-45.
  37. [37] Reinhold JA & Rickels K. Pharmacological treatment for generalized anxiety disorder in adults: an update. Expert Opinion in Pharmacotherapy 2015; 16: 1669-81. DOI: 10.1517/14656566.2015.1059424
  38. [38] Misri S, Abizadeh J, Sanders S, Swift E. Perinatal generalized anxiety disorder: Assessment and treatment. Journal of Women’s Health 2015; 24: 762-70.
  39. [39] Bérard A, Iessa N, Chaabane S, Muanda FT, Boukhris T, Zhao JP. The risk of major cardiac malformations associated with paroxetine use during the first trimester of pregnancy: a systematic review and meta-analysis. British Journal of Clinical Pharmacology 2016; 81: 589-604.
  40. [40] Orsolini L & Bellantuono C. Serotonin reuptake inhibitors and breastfeeding: a systematic review. Human Psychopharmacology 2015; 30: 4-20.
  41. [41] Bellantuono C, Vargas M, Mandarelli G, Nardi B, Martini MG. The safety of serotonin-noradrenaline reuptake inhibitors (SNRIs) in pregnancy and breastfeeding: a comprehensive review. Human Psychopharmacology 2015; 30: 143-51.
  42. [42] Goodman JH, Watson GR, Stubbs B. Anxiety disorders in postpartum women: A systematic review and meta-analysis. Journal of Affective Disorders 2016; 203: 292-331.
  43. [43] Weaver J, Browne J, Aras-Payne A, Magill-Cuerden J. A comprehensive systematic review of the impact of planned interventions offered to pregnant women who have requested a caesarean section as a result of tocophobia (fear of childbirth). JBI Library of Systematic Reviews 2012; 10: 1-20.
  44. [44] Marchesi C. Pharmacological management of panic disorder. Neuropsychiatric Disease and Treatment 2008; 4: 93-106. PMID: 18728820.
  45. [45] Andersson L, Sundström-Poromaa I, Wulff M, Aström M, Bixo M. Depression and anxiety during pregnancy and six months postpartum: a follow-up study. Acta Obstetrics & Gynecology Scandinavia 2006; 85(8): 937-44. DOI: 10.1080/00016340600697652
  46. [46] Manber R, Blasey C, Allen JJ. Depression symptoms during pregnancy. Archives of Women’s Mental Health 2008; 11(1): 43-8.
  47. [47] Carter D & Kostaras X. Psychiatric disorders in pregnancy. BCMJ 2005; 47(2): 96-99.
  48. [48] Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM. Risk factors for depressive symptoms during pregnancy: a systematic review. American Journal of Obstetrics and Gynecology 2010; 202 (1): 5-14.
  49. [49] Galbally M, Snellen M, Lewis A (Eds.). Psychopharmacology and Pregnancy. Treatment Efficacy, Risks, and Guidelines. Springer; 2014.
  50. [50] Nestler EJ, Barrot M, DiLeone RJ, Eisch AJ, Gold SJ, Monteggia LM. Neurobiology of depression. Neuron 2002; 34(1): 13-25. PMID: 11931738.
  51. [51] Cohen LS, Altshuler LL, Harlow BI, Nonacs R, Newport DJ, Viguera AC et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA 2006; 295:499-507.
  52. [52] Mota N, Cox BJ, Enns MW, et al. The relationship between mental disorders, quality of life, and pregnancy: findings from a nationally representative sample. Journal of Affective Disorders 2008; 109: 300-4.
  53. [53] Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A metaanalysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Archives of General Psychiatry 2010; 67(10): 1012-1024.
  54. [54] Grigoriadis S, VonderPorten EH, Mamisashvili L, Tomlinson G, Dennis CL, Koren G, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. Journal of Clinical Psychiatry 2013; 74: e321-341.
  55. [55] Jarde A, Morais M, Kingston D, Giallo R, MacQueen GM, Giglia L, et al. Neonatal outcomes in women with untreated antenatal depression compared with women without depression: a systematic review and meta-analysis. JAMA Psychiatry 2016; 73(8): 826-837.
  56. [56] Huang HC, Sung FC, Chen PC, Chang CY, Muo CH, Shiue HS, et al. Obstetric outcomes in pregnant women with and without depression: population-based comparison. Science Reports 2017; 7(1): 13937.
  57. [57] Seth S, Lewis AJ, Galbally M. Perinatal maternal depression and cortisol function in pregnancy and the postpartum period: a systematic literature review. BMC Pregnancy Childbirth 2016; 16(1): 124.
  58. [58] Reynolds RM, Labad J, Buss C, Ghaemmaghami P, Räikkönen K. Transmitting biological effects of stress in utero: implications for mother and offspring. Psychoneuroendocrinology 2013; 38(9): 1843-1849.
  59. [59] Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, et al. Effects of perinatal mental disorders on the fetus and child. Lancet 2014; 384(9956): 1800-819. DOI: 10.1016/S0140-6736(14)61277-0
  60. [60] Wan MW & Green J. The impact of maternal psychopathology on childmother attachment. Archives of Women’s Mental Health 2009; 12(3): 123-34.
  61. [61] López Seco F, Mundo-Cid P, Aguado-Gracia J, Gaviria-Gómez AM, Acosta-García S, Martí-Serrano S, et al. Insecure maternal attachment is associated with depression in ADHD children. Attention Deficit Hyperactive Disorder 2016; 8(4): 189-196.
  62. [62] McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, et al. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy
  63. and postpartum 2017. Journal of Psychopharmacology 2017; 31(5): 519-552. DOI: 10.1177/0269881117699361
  64. [63] Viguera AC, Whitfield T, Baldessarini RJ, Newport DJ, Stowe Z, Reminick A, et al. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. American Journal of Psychiatry 2007; 164(12): 1817-24.
  65. [64] Marangell LP. Current issues: women and bipolar disorder. Dialogues in Clinical Neuroscience 2008; 10(2): 229-38. PMID: 18689292.
  66. [65] Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RM, Petukhova M, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey Replication. Archives of General Psychiatry 2007; 64(5): 543-52.
  67. [66] American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, Fifth edition. American Psychiatric Association, Washington, DC; 2013.
  68. [67] Munk-Olsen T, Munk Laursen T, Mendelson T, Pedersen CB, Mors O, Mortensen PB. Risks and predictors of readmission for a mental disorder during the postpartum period. Archives of General Psychiatry 2009; 66: 189-95.
  69. [68] Sharma V & Pope CJ. Pregnancy and Bipolar Disorder: a systematic review. Journal of Clinical Psychiatry 2012; 73(11): 1447-55.
  70. [70] Ennis ZN & Damkier P. Pregnancy exposure to olanzapine, quetiapine, risperidone, aripiprazole and risk of congenital malformations. A systematic review. Basic Clinical Pharmacology and Toxicology 2015; 116(4): 315-20.
  71. [71] Sadowski A, Todorow M, Yazdani Brojeni P, Koren G, Nulman I. Pregnancy outcomes following maternal exposure to second-generation antipsychotics given with other psychotropic drugs: a cohort study. BMJ Open 2013; 3(7).
  72. [72] Coughlin CG, Blackwell KA, Bartley C, Hay M, Yonkers KA, Bloch MH. Obstetric and neonatal outcomes after antipsychotic medication exposure in pregnancy. Obstetrics and Gynecology 2015; 125(5): 1224-35. DOI: 10.1097/AOG.0000000000000759
  73. [73] Yatham L, Kennedy S, Parikh V, Schaffer A, Bond D, Frey B, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT)/International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder; 2018.
  74. [74] Provencher MD, Hawke LD, Thienot E. Psychotherapies for comorbid anxiety in bipolar spectrum disorders. Journal of Affective Disorders 2011; 133(3): 371-80.
  75. [75] Tomson T, Battino D, Bonizzoni E, Craig J, Lindhout D, Perucca E, et al. Dose-dependent teratogenicity of valproate in mono- and polytherapy: an observational study. Neurology 2015; 85(10): 866-72. DOI: 10.1212/WNL.0000000000001772
  76. [76] Tomson T, Battino D, Perucca E. Valproic acid after five decades of use in epilepsy: time to reconsider the indications of a time-honoured drug. Lancet Neurol 2016; 15(2): 210-218. DOI: 10.1016/S1474-4422(15)00314-2
  77. [77] Vigod SN, Kurdyak PA, Dennis CL, Gruneir A, Newman A, Seeman MV. Maternal and newborn outcomes among women with schizophrenia: a retrospective population based cohort study. BJOG: An International Journal of Obstetrics and Gynaecology 2014; 121: 566-574. DOI: 10.1111/1471-0528.12567
  78. [78] Howard LM. Fertility and pregnancy in women with psychotic disorders. European Journal of Obstetrics Gynaecology and Reproductive Biology 2005; 119: 3-10.
  79. [79] Laursen TM & Olsen TM. Reproductive patterns in psychotic patients. Schizophrenia Research 2010; 121: 234-240.
  80. [80] Matevosyan NR. Pregnancy and postpartum specifics in women with schizophrenia: a meta-study. Archives of Gynecology and Obstetrics 2011; 283: 141-147.
  81. [81] Solari H, Dickson KE, Miller L. Understanding and treating women with schizophrenia during pregnancy and postpartum. Canadian Journal of Clinical Pharmacology 2009; 16: e23-e32. PMID: 19164844.
  82. [82] Robinson GE. Treatment of schizophrenia in pregnancy and postpartum. Journal of Population Therapeutics and Clinical Pharmacology 2012; 19: 380-386. PMID: 23075483.
  83. [83] Barnes TRE and the Schizophrenia Consensus Group of the British Association for Psychopharmacology. Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology 2011; 25: 567-620. DOI: 10.1177/0269881110391123
  84. [84] Nilsson E, Hultman CM, Cnattingius S, Olausson PO, Björk C, Lichtenstein P. Schizophrenia and offspring’s risk for adverse pregnancy outcomes and infant death. British Journal of Psychiatry 2008; 193: 311-315. 10.1192/bjp.bp.107.045146.
  85. [85] King-Hele S,Webb RT, Mortensen PB, Appleby L, Pickles A, Abel KM. Risk of stillbirth and neonatal death linked with maternal mental illness: a national cohort study. Archives of Disease in Childhood Fetal Neonatal Edition 2009; 94: 105-110.
  86. [86] Einarson A. Antipsychotic medication (safety/risk) during pregnancy and breastfeeding. Current Women’s Health Review 2010; 6: 34-38. DOI: 10.2174/157340410790979789
  87. [87] Dodd S & Berk M. The Safety of Medications for the Treatment of Bipolar Disorder During Pregnancy and the Puerperium. Current Drug Safety 2006; 1: 25-33. PMID: 18690912.
  88. [88] Poo SXW & Agius M. Atypical antipsychotics for schizophrenia and/or bipolar disorder in pregnancy: Current recommendations and updates in the NICE guidelines. Psychiatria Danubina 2015; 27 (S1): 255-260. PMID: 26417775.

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Laura Orsolini, Domenico De Berardis, Cesario Bellantuono, The ‘hidden’ and ‘forgotten’ psychiatry: The Perinatal Psychiatry in "RIVISTA SPERIMENTALE DI FRENIATRIA" 1/2019, pp 35-58, DOI: 10.3280/RSF2019-001003