Safety and Efficacy of Antipsychotics in Pregnancy and Lactation

Abstract

The clinical profiles of antipsychotic medications have improved dramatically since the first generation was introduced in the 1950s. Second Generation Antipsychotic medications (SGAs), which became available in 1990, generate fewer side effects, including reduced incidence of extrapyramidal symptoms such as hyperprolactinemia. This improves the female patients’ ability to become pregnant, a process which is compromised by first generation drugs. However, use of antipsychotic medications has become increasingly prevalent. The likelihood of females with depression, bipolar disorder, psychosis to have an unplanned pregnancy, and the incidence of foetal exposure to psychotropic drugs during the first trimester of pregnancy has also increased. The paucity of exposure and outcome data leaves the safety and effects of use of antipsychotic medications during pregnancy as a subject to controversy. The evidence is insufficient to provide adequate support for clinical practices, and also to the professionals in the related fields of psychiatry, obstetrics-gynecology, and primary care. There is often contradicting information given to patients due to the lack of current studies pertaining to this area. The studies of SGA’s use during breastfeeding suggest that olanzapine, risperidone, and quetiapine may be safe at certain levels whereas medications like clozapine achieve relatively high concentrations in breast milk and may cause agranulocytosis and somnolence. Therefore, the purpose of this review is to report the most relevant and up-to-date findings of antipsychotic medication use during pregnancy and lactation in detail, so that physicians may have more insight regarding medications and provide female patients of childbearing potential with knowledge of the benefits and risks of antipsychotic drugs.