Schizophrenia Treatment: During Pregnancy & Postpartum- Update

Typical Antipsychotics

* Teratogenesis:
- no increase in teratogenesis in women taking piperidyl phenothiazines (thioridizine), piperazines (fluphenazine, perphenazine), phenothiazines (chlorpromazine, promethazine), piperazine phenothiazines (trifluoperazine), butyrophenones (haloperidol), thioxanthenes (flupenthixol), dibenzoxazepines or diphenylbutylpiperidines.

* 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)

* 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.

* 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

* 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.

* Labour and Delivery:
- Exposure to atypical antipsychotics during pregnancy did not cause an increased risk for adverse pregnancy outcomes.

* 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.

* Long-Term Effects:
- Normal development has been reported in the offspring of women taking atypical antipsychotics
in pregnancy.



- Little researched but may be teratogenic and are best avoided in pregnancy



- May cause a small increase in miscarriage risk but
- Do not appear to cause an increase in major malformations.



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