Can you take antipsychotics while pregnant?

Antipsychotics are primarily prescribed for the treatment of psychotic disorders, such as schizophrenia, schizoaffective disorder, and, at times, bipolar disorder.

They are proven to be effective at managing psychotic symptoms and can minimize the disruption your psychotic disorder causes in your life, providing you satisfy the requirements of your doctor’s physical examination for prescription.

But what if you’re pregnant? As prospective new parents, you want to ensure that both mother and child remain safe and healthy throughout the pregnancy. This article will assess the risks and benefits of using antipsychotics when pregnant.

Is it safe to take antipsychotics while pregnant?

It is not clear whether antipsychotic use during pregnancy is safe or not, with studies offering conflicting results. Some of the known risks include: ^[1]

• Your baby’s development during the first trimester: The first three months of pregnancy is when your unborn baby is at its most vulnerable. Taking antipsychotics during this period may impact its growth.
• Your baby’s development in the third trimester: The risk of harm increases as your baby’s birth nears, particularly in the last few weeks of the pregnancy. ^[1]
• Gestational diabetes and sudden weight gain: Studies show that taking antipsychotics can make you more susceptible to weight gain and diabetes. ^[1] Gestational diabetes is a variant that comes on during pregnancy as your body loses its ability to produce enough insulin. It can cause complications during a pregnancy and your doctor will most likely monitor you closely for any signs during the process.
• Antipsychotics being passed to your baby through breast milk: Whilst this is a post-partum problem, it’s worth noting that your baby could experience side effects from antipsychotics passed down through breast milk. Your doctor will help you balance the risks and benefits of breastfeeding whilst on antipsychotics and you can make the best decision based on your personal situation.
• Scarcity of clinical testing on pregnant women: As a result, there is not much evidence on the safety of taking antipsychotics when pregnant. Whilst newer drugs may prove effective at managing psychotic symptoms, they carry a higher risk to unborn children than older antipsychotics as scientists have had less time to draw conclusions around them.

Whilst it’s worth keeping these risks in mind, it is important to underline the potential benefits of antipsychotic treatment during pregnancy: ^[1]

• You weigh up the risks and decide antipsychotics are best for your and your baby’s health: You may have been successfully managing your psychotic order with antipsychotic treatment when you learned you were pregnant. You may not want to stop antipsychotic treatment as you think your symptoms will deteriorate and you will not be able to function. This means you decide the best course of action for you, your baby,and other family members is for you to continue taking antipsychotics.
• Some studies indicate a high relapse rate for people with psychotic disorders who stop treatment: A 1995 literature review found that 53% of patients with schizophrenia who stopped taking antipsychotics relapsed over a 10-month period, compared to the 16% who continued treatment. ^[2] Rapid withdrawal from treatment following a pregnancy diagnosis was considered a key predictor of relapse. ^[2]

Ultimately, we are not certain whether antipsychotic use during pregnancy is 100% safe. ^[2]

However, the risks of not treating two of the most prominent mental disorders, schizophrenia and bipolar disorder, during an affected person’s pregnancy are significant. ^[3]

Potential pregnancy complications include placental abnormalities, antepartum hemorrhage, prematurity, pre-eclampsia, low birth weight, intrauterine growth retardation, fetal distress, neonatal hypoglycemia, low Apgar score, stillbirth, and congenital defects. ^[3]

Additionally, concerns can be raised about the parenting and long-term development of a child if their mother does not undergo treatment for a psychotic disorder. ^[3]

The decision to use antipsychotic medication during pregnancy should always be made in consultation with a qualified healthcare professional. Balancing the potential risks and benefits is crucial, as both the well-being of the pregnant person and the potential impact on the developing fetus need to be considered.

Can antipsychotic medication make it harder to get pregnant?

Some antipsychotic medications can increase the level of a hormone called prolactin which can make it harder for a person to get pregnant. ^[2] Your doctor will typically monitor your prolactin levels during your course of antipsychotic medication.

If you are taking antipsychotics and struggling to get pregnant, your doctor may switch you onto a different antipsychotic that is less likely to increase prolactin levels, such as aripiprazole, olanzapine, or quetiapine. ^[2]

Do antipsychotics cause any birth defects?

Largely, studies focusing on 10,000 or more participants have found no overall increased risk of birth defects in pregnant women who use antipsychotic medication. ^[2]

One study suggests that there might be a slightly increased risk of certain birth defects associated with the antipsychotic medication, risperidone, during pregnancy. ^[2] However, the risk appears to be relatively small, and the exact risks can vary depending on the specific medication, the dosage, the timing of exposure during pregnancy, and individual factors.

If you are taking risperidone, consult a specialized healthcare provider, such as a perinatal psychiatrist, for advice. ^[2]

Do antipsychotics increase the chance of miscarriage?

Roughly one in five pregnancies end in miscarriage irrespective of any medication a woman has taken. The relationship between antipsychotics and miscarriage is not fully understood, but the information we have indicates that antipsychotics do not increase the risk of miscarriage. However, we need more information to be certain. ^[2]