Chisolm and Payne conducted a literature review to summarize the known and unknown risks of using psychotropic drugs during pregnancy. 15% of pregnant women have a psychiatric illness and 10% to 13% of fetuses are exposed to a psychotropic medication. Studies showed that many women relapsed if their medications were discontinued during pregnancy. It was found that most classes of psychotropic drugs are relatively safe to the fetus during pregnancy. A risk-benefit analysis should be conducted to determine if the risks associated with the drug or untreated psychiatric disorder are worse.
CYP1A2 enzymes are down-regulated in pregnant women so medications such as olanzapine and clozapine require a lower dose. Additionally, these medications have an increased risk for maternal weight gain, increased infant birth weight, and gestational diabetes, so ultrasound monitoring of fetal size may be beneficial in late pregnancy. High potency first generation antipsychotics are recommended over low potency first generation antipsychotics to minimize maternal anticholinergic, hypotensive, and antihistamine effects. Second generation antipsychotics are no safer than first generation antipsychotics and may have an increased risk of high infant birth weight and hypoglycemia.
There is still an inadequate amount of literature on the safety of antipsychotic use in pregnant women. Focus should be emphasized on drug management during pregnancy, including before and after delivery. The psychotropic medications should not be suddenly discontinued, and a comprehensive treatment plan should be developed for women to ensure quality and safe care to the mother and developing fetus.
There is still not enough evidence to completely decide which antipsychotics are safe during pregnancy. What other medications could potentially be safe during pregnancy but are often discontinued due to a lack of research? And why?