Schizophrenia Treatment: During Pregnancy & Postpartum

Schizophrenia Treatment: 

During Pregnancy & Postpartum

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(1) ANTIPSYCHOTICS

Typical Antipsychotics

(a) Teratogenesis:

  • No increase in teratogenesis in women taking thioridizine, fluphenazine, perphenazine, chlorpromazine, promethazine, trifluoperazine, haloperidol or flupenthixol.

(b) Labour and Delivery:

  • Those exposed to typical antipsychotics during pregnancy had a significantly lower mean birth weight and a higher incidence of small for gestational age infants (?? not consistent among other studies).

(c) Effects on the Neonate:

    • Chlorpromazine, Flupenthixol and Fluphenazine have been associated with a risk of neonatal withdrawal and extrapyramidal signs that may last for weeks to months.

 

  • Use of promethazine in late pregnancy could induce respiratory distress in the newborn and impaired platelet aggregation in the mother and the newborn.

(d) Long-Term Effects:

  • No differences have been found in behavior, socialization or cognition in nine and ten year olds who were exposed to chlorpromazine in utero.

Atypical Antipsychotics

(a) Teratogenesis:

    • There is no conclusive evidence of an increased risk of teratogenesis.

 

  • There may, however be an indirect risk: the use of atypicals during pregnancy may lead to weight gain that, in turn, can increase the risk for neural tube defects, hypertension, pre-eclampsia and gestational diabetes.

(b) Labour and Delivery:

  • Exposure to atypical antipsychotics during pregnancy did not cause an increased risk for adverse pregnancy outcomes.

(c) Effects on the Neonate:

    • Infants exposed to atypical antipsychotics had a significantly higher incidence of large for gestational age.

 

  • Increased risk of hypoglycaemia and macrosomia resulting in shoulder dystocia and associated birth injuries such as fractures and nerve palsies.

(d) Long-Term Effects:

  • Normal development has been reported in the offspring of women taking atypical antipsychotics in pregnancy.

NOTE: 

  • Among Typicals: High potency are preferred (haloperidol, Perphenazine, Trifluoperazine).
  • Studies with Atypicals: Risk of teratogenicity is not known; and data is sparse. 

 


 

(2) ANTIDEPRESSANTS
    • May cause a small increase in miscarriage risk but

 

  • Do not appear to cause an increase in major malformations.

 


(3) BENZODIAZEPINES
    • No increases in malformations have been reported with lorazepam, clonazepam, alprazolam, triazolam or flurazopam.

 

    • Withdrawal syndromes may be seen after use of clonazepam, alprazolam, and lorazepam.

 

    • Lorazepam used in late pregnancy may lead to respiratory distress, decreased APGARS, problems with temperature regulation and poor feeding.

 

    • No malformations or delivery problems have been reported with zopiclone use.

 

  • Low birth weight, preterm deliveries and small for gestational age babies have been found after the use of zopildem.

 


(4) ANTICHOLINERGICS
  • Little researched but may be teratogenic and are best avoided in pregnancy

Source: J Popul Ther Clin Pharmacol Vol 19(3):e380-e386; 2012

 

Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


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