The management of psychiatric illness during pregnancy requires a risk-benefit analysis; physicians must weigh the benefits of treating severe psychiatric illness in pregnant patients with the possible risks to the mother of non-treatment and the risks to the developing fetus secondary to exposure to psychotropic medication. Unfortunately for many pregnant women, discontinuation of their antipsychotic medication is not an option; the risk of relapse, recurrent illness, suicide and difficulty in returning to a non-psychotic state if relapse were to occur is too great. Treating physicians will often advise these women to continue their medications throughout pregnancy.
Unfortunately, there has not been clear evidence on which antipsychotic medication is safest in pregnancy and lactation. Two articles have recently reviewed the safety of antipsychotic drugs in pregnancy. And even review articles have highly different outcomes, despite, for the most part, utilizing the same source of articles. What is needed at this time is guidance in choosing an antipsychotic medication in a medication naive pregnant patient or a woman contemplating pregnancy. Prospective cohort studies are attractive studies to contribute to a better understanding in the selection of effective drugs to afford this problem.
Keywords: Pregnancy, first-generation, antipsychotics, second-generation antipsychotics, atypical antipsychotics, adverse outcomes, teratogenicity, birth defects, fetal toxicity
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