For those with psychotic disorders, finding the right medication or
combination of medication can be a trying endeavor fraught with periodic
episodes of illness and medication side effects. Add pregnancy to the mix, and
treatment success may become even more elusive as concerns for the health of
the developing fetus take a prominent role in treatment considerations.
According to researchers, maternal mental health doesn't necessarily have
to come at the expense of newborns' health. A pre-conception evaluation allows
couples to formulate a plan "to minimize exposure of the fetus to
unnecessary medications as well as preventing possible recurrence of
psychiatric illness that may ensure from medications changes," according
to a clinical case conference in the December 2006 American Journal of
Deborah Yaeger, M.D., lead author of the article, told Psychiatric
News, "The decision to use medications during pregnancy should
always be driven by a risk-benefit assessment that weighs the risks of the
mother of being off medications against the potential risk to fetal exposure
of the medication."
Yaeger is a clinical professor of psychiatry at the UCLA David Geffen
School of Medicine and director of psychiatric services at the Women's
Comprehensive Care Center of the VA Greater Los Angeles Healthcare System.
In the article, Yaeger presented the case of a 38-year-old married woman
who had schizophrenia and wished to become pregnant. During an earlier
pregnancy, "Ms. A" elected to end the pregnancy after being told
that the quetiapine could be harmful to the fetus. Ms. A's psychiatric
consultation consisted of a detailed psychiatric and medical history followed
by an in-depth discussion of the risks and benefits of medication use during
pregnancy and postpartum.
Given Ms. A's history of severe psychosis and suicide attempts, it was
decided if she became pregnant again, she should remain on medications during
pregnancy and possibly through lactation.
According to the article, many women with psychotic disorders have
children. However, mothers with schizophrenia are more likely than those
without it to be unmarried and have limited social support.
According to a study by Laura Miller, M.D., appearing in the Fall 1997
Schizophrenia Bulletin, the majority of mothers with schizophrenia in
one sample experienced loss of custody and their children are placed in foster
In addition, Yaeger cited a study led by Lori Altshuler, M.D., in the May
1996 American Journal of Psychiatry showing that women with
schizophrenia tended to receive less prenatal care, have poorer nutrition, and
use more tobacco, alcohol, and illicit drugs compared with women without
schizophrenia. "These exposures may be far worse than psychiatric
medications," Yaeger pointed out.
In addition, there appears to be increasing evidence about the risks that
psychosis itself poses to pregnancy, Yaeger noted.
Emma Nilsson, Ph.D., and colleagues found that women who experienced a
psychotic episode during pregnancy had twice the rate of adverse pregnancy
outcomes—including stillbirth, fetal death, and premature
delivery—as compared with those who did not have a psychotic episode.
Her study was published in the December 2002 Schizophrenia
When weighing the risks and benefits of medication during pregnancy,
psychiatrists usually turn to the literature to find data on the effects of
certain medications on pregnancy outcomes. But in the case of antipsychotic
medications and pregnancy, not much information is available. However, it is
known that common side effects of second generation antipsychotic medications
include weight gain, hypertension, and diabetes, the article pointed out,
which can complicate pregnancy.
One way to potentially diminish this risk is for physicians to assist
patients taking atypical antipsychotics to limit weight gain both before and
during pregnancy, Yaeger said. Having women participate in weight-management
support groups and providing them financial assistance to purchase healthy
foods might improve pregnancy outcomes both for mother and baby, she
In addition, it may be helpful for physicians treating pregnant women with
psychotic disorders to ensure that the women are receiving ancillary services
such as high-risk obstetrical care, social work appointments, and frequent
psychiatric re-evaluations, Yaeger noted.
"Atypical Antipsychotics in the Treatment of Schizophrenia
During Pregnancy and the Postpartum" is posted on the Web at<ajp.psychiatryonline.org/cgi/content/full/163/12/2064>.▪