Antipsychotic use during pregnancy should be guided by the considerations outlined in Principles of psychotropic use during pregnancy.
Avoid switching antipsychotics during pregnancy because it increases the risk of fetal adverse effects from exposure to multiple drugs and relapse of the psychiatric disorder.
If treating a new-onset disorder during pregnancy, seek expert advice. It is preferable to use an antipsychotic with the most safety
data and highest ranking for the relevant disorder (eg
bipolar disorder,
psychoses).
Clozapine,
haloperidol,
olanzapine,
quetiapine and
risperidone have the most safety data
McAllister-Williams 2017. Fewer data are available for
amisulpride,
aripiprazole,
chlorpromazine,
lurasidoneCohen 2023Montiel 2022,
periciazine,
ziprasidone and
zuclopenthixol; there are no published data for
asenapine,
brexpiprazole,
cariprazine, and
paliperidone during pregnancy. Paliperidone is the active metabolite of risperidone; although there are no published data for paliperidone in pregnancy, it may be reasonable for risperidone data to be applied to paliperidone. The malformation rate from the antipsychotics described above is only marginally elevated above the background rate and this may be due to psychiatric disorder, not the drug. The risk of pregnancy complications does not appear to be increased with antipsychotics. However, depending on the
adverse effect profile of the drug, monitor the patient for gestational diabetes. Poor neonatal adaptation has only been described in case reports.
Continue long-acting injectable antipsychotic formulations during pregnancy, although there are minimal pregnancy data to guide their use. Mental health stability is crucial to the wellbeing of the patient and the fetus.
An increasing number of studies on developmental outcomes of in utero exposure to antipsychotics demonstrate no difference in the incidence of neurodevelopmental disorders between exposed infants and nonexposed infantsBruno 2024Straub 2022.
