Use and Safety of Antipsychotic Drugs During Pregnancy
Abstract
The incidence of schizophrenia in the general population ranges from about 1% to 2%. Schizophrenia affects men and women equally, occurring in all cultures and socioeconomic classes. The peak age of onset in women is 25 to 35 years, which are also the peak childbearing years, and women with psychotic illnesses are likely to have more unplanned pregnancies than women without a psychotic illness. Not only are antipsychotic medications prescribed for schizophrenia, but, especially since the introduction of the second-generation (atypical) antipsychotics, these drugs are also used to treat other psychiatric illnesses such as bipolar disorder. As a result, there is an increase in the number of women requiring antipsychotic drug therapy who are likely to become pregnant. It is important to evaluate the safety of these drugs in pregnancy, as most women with a serious psychiatric illness cannot stop taking their medication, as this would interfere with their activities of daily living, especially taking care of an infant. In this review, we describe available up-to-date, evidence-based information regarding the safety of antipsychotic drugs that are currently used in pregnancy. These include first-generation (conventional) antipsychotics (eg, promethazine, chlorpromazine, prochlorperazine, haloperidol, perphenazine, trifluoperazine, loxapine, thioridazine, flupenthixol, fluphenazine) and second-generation antipsychotics (eg, clozapine, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, paliperidone). To date, no definitive association has been found between use of antipsychotics during pregnancy and an increased risk of birth defects or other adverse outcomes. However, there is a paucity of information, with a lack of large, well designed, prospective comparative studies. The information presented here should therefore not be interpreted as conclusive with regard to the safety of these drugs, as more research is needed. Women who require treatment should always discuss the risks and benefits of pharmacotherapy with their physician and, if it is felt that treatment should be continued during pregnancy, the evidenced-based information presented here will be of help in this important decision.
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Most women with SMI cannot stop taking their medication, as this would interfere with their activities of daily living, especially taking care of an infant.
“Most women with a SMI cannot stop taking their medication, as this would interfere with their activities of daily living, especially taking care of an infant (555).”
From Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care (2011) · cites this paper as [555]
No definitive association has been found up to now between the use of antipsychotics during pregnancy and an increased risk of birth defects or other adverse outcomes.
“However, no definitive association has been found up to now between the use of AP during pregnancy and an increased risk of birth defects or other adverse outcomes (555,556).”
From Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care (2011) · cites this paper as [555]
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- Authors
- Einarson, A., & Boskovic, R.
- Affiliations
- University of Toronto (CA)
- Corresponding author
- Einarson, Adrienne
- Venue
- Journal of Psychiatric Practice
- Published
- 2009-05
- Volume
- 15
- Issue
- 3
- Pages
- 183-192
- ISSN
- 1527-4160 (ISSN-L)
- 1538-1145
- OpenAlex
- W1979191992
- Cited by
- 167
- References
- 48
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 5 · 2023: 7 · 2022: 10 · 2021: 7 · 2020: 9 · 2019: 8 · 2018: 6 · 2017: 8 · 2016: 14 · 2015: 18 · 2014: 14 · 2013: 9 · 2012: 15
- FWCI
- 15.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychiatric Practice (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
- Keywords
- antipsychotic drugs, pregnancy, drug safety, schizophrenia, bipolar disorder, typical antipsychotics, atypical antipsychotics, congenital malformations, teratogenicity, risk-benefit decision-making
- MeSH terms
- Abnormalities, Drug-Induced, Contraindications, Bipolar Disorder, Female, Humans, Hyperemesis Gravidarum, Infant, Newborn, Pregnancy, Pregnancy Complications, Schizophrenia, Schizophrenic Psychology, Antipsychotic Agents, Risk Assessment, Evidence-Based Medicine
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