Antipsychotic Use in Pregnancy: Patient Mental Health Challenges, Teratogenicity, Pregnancy Complications, and Postnatal Risks
and Alan D. Kaye 5Round 1
Reviewer 1 Report
The title "Antipsychotic Use in Pregnancy", the main point is the complication of pregnancy and the effect on the fetus. ANTIPSYCHOTICS OVERVIEW/CLASSE section needs summary.
The antipsychotic agent increased body weight of mothers and fetal, however this review described about increase lower birth weight, what meant?(line 340)
It needs to provide a summary about different complications in mother and infant for the readers to easily understand.
Author Response
The title "Antipsychotic Use in Pregnancy", the main point is the complication of pregnancy and the effect on the fetus. ANTIPSYCHOTICS OVERVIEW/CLASSE section needs summary.
Answer: Thank you for this point as we agree that this was missed. This summary was added.
The antipsychotic agent increased body weight of mothers and fetal, however this review described about increase lower birth weight, what meant?(line 340)
Answer: This was fixed to highlight because there is a difference in antipsychotic use where it’s increased but untreated psychosis it tends to be decreased. Also, sometimes cofounding factors such as smoking can actually cause a decreased weight.
It needs to provide a summary about different complications in mother and infant for the readers to easily understand.
Answer: A table about complications summarizes the complications in the mother and infant was added.
Reviewer 2 Report
This is in general a well-written review. However, there are some revisions required as follows:
The authors have talked about primary and secondary psychotic disorders, but I did not see discussion of borderline PD, which is much more frequent in women and these patients can sometimes be treated with antipsychotic drugs to carry the birth risks.
Abbreviations are not used consistently for example line 95 shows the use of the term antepartum depression rather than APD.
The length of the article is a concern, it is too long for a full text read. If the authors don't describe the not-needed clinical features of every disorder associated with psychosis, the length can be reduced.
Discussion of reserpine needs to include why it was never a safe agent to manage psychosis or depression, combining it with chlorpromazine can be misleading.
There are some statements about the differences between typical and atypicals that require changes. LIne 157 states that atypicals are better than typical in causing EPS, though it is true for clozapine and quetiapine, it is not exactly the case with several other atypicals. FOr example risperidone, an atypical had been shown to cause more hyperprolactinemia (and maybe more EPS) than even haloperidol, esp at higher doses. Similarly, clozapine which is considered a typical agent has a lot of characteristics that resemble atypicality.
Furthermore, line 162 states that EPS distinguishes between typical and atypicals, which is not true as stated above.
There is significant redundancy in describing fetal risks with antipsychotic drugs, the length of the article can be further reduced by removing similar statements in this regard.
Author Response
The authors have talked about primary and secondary psychotic disorders, but I did not see discussion of borderline PD, which is much more frequent in women and these patients can sometimes be treated with antipsychotic drugs to carry the birth risks.
Answer: This is a good point and we thank you for pointing that out. A short discussion of this was added to the manuscript.
Abbreviations are not used consistently for example line 95 shows the use of the term antepartum depression rather than APD.
Answer: Abbreviations were double checked to make sure that they are consistent, however, APD is defined as antepartum psychiatric disorder and depression in the antepartum period wanted to be emphasized which is why the more general term wasn’t used.
The length of the article is a concern, it is too long for a full text read. If the authors don't describe the not-needed clinical features of every disorder associated with psychosis, the length can be reduced.
Answer: This is also a good point. The length of certain sections was shortened.
Discussion of reserpine needs to include why it was never a safe agent to manage psychosis or depression, combining it with chlorpromazine can be misleading.
Answer: This was actually meant to be taken out so it was removed from this draft.
here are some statements about the differences between typical and atypicals that require changes. LIne 157 states that atypicals are better than typical in causing EPS, though it is true for clozapine and quetiapine, it is not exactly the case with several other atypicals. FOr example risperidone, an atypical had been shown to cause more hyperprolactinemia (and maybe more EPS) than even haloperidol, esp at higher doses. Similarly, clozapine which is considered a typical agent has a lot of characteristics that resemble atypicality
Answer: This has been fixed
Furthermore, line 162 states that EPS distinguishes between typical and atypicals, which is not true as stated above.
Answer: This has been taken out.
Round 2
Reviewer 1 Report
D2, 5-HT,EPS in table 1, please support full descriptions under the table.
FGA, SGA, LGA, BSID-III in table 2, please support full descriptions under the table.
EPS ,LGA? Please support full descriptions in table 3 under the table.
Author Response
D2, 5-HT,EPS in table 1, please support full descriptions under the table.
answer: Described what this is in the table
FGA, SGA, LGA, BSID-III in table 2, please support full descriptions under the table.
Answer: described in the table. BSID-III is already defined in the text
EPS ,LGA? Please support full descriptions in table 3 under the table.
Answer: EPS and LGA were defined earlier in the text
Reviewer 2 Report
Table 1 is confusing and should be removed.
Author Response
Table one was removed
