Pediatric Drugs

, Volume 2, Issue 2, pp 83–90 | Cite as

Effects of Antipsychotics on the Unborn Child

What Is Known and How Should This Influence Prescribing?
Review Article


The onset of psychosis during pregnancy presents difficult management decisions. A complete and thorough physical and obstetric examination is always warranted to look for possible physiological precipitants. The treatment of pregnant patients with psychotic symptomatology requires close contacts between family members, non-physician professionals involved in the patient’s care (e.g. social workers, case managers and home healthcare nurses), and the physicians overseeing the patient’s management (e.g. internists, obstetricians and psychiatrists). In mild and less disabling cases it may be possible to avoid medication intervention but this approach risks adverse behaviour consequences resulting from a possible worsening of the patient’s symptomatology. Avoiding medication requires an environment in which the patient has strong social supports. Risks are present whether medication is initiated or not, and treatment decisions require a careful assessment of the risks and benefits involved.

Initiating medication raises the possibility of obstetric, teratogenic, neurobehavioural and neonatal toxic effects. Research on the risks imposed by antipsychotic drug use during pregnancy is incomplete and raises questions regarding appropriate management. The first trimester represents a period of increased susceptibility to medication-induced teratogenesis. The use of low potency phenothiazines during the first trimester may increase the risk of congenital abnormalities by an additional 4 cases per 1000 (odds ratio = 1.21, p = 0.04) The pharmacological profiles of antipsychotic medications also present adverse effects which need to be considered during pregnancy (hypotension, sedation, etc.). Less is known about the risk of adverse consequences resulting from the use of newer atypical antipsychotic medications.

Electroconvulsive therapy is another treatment modality and its use may circumvent the need to introduce antipsychotic medication during pregnancy. It must be stressed that, given current knowledge, no treatment regimen can be considered completely safe. Ultimately many factors must be evaluated when treating psychosis during pregnancy, however, no decision is risk-free.


  1. 1.
    Strauss GD. Diagnosis and psychiatry: examination of the psychiatric patient. In: Kaplan HI, Sadock BJ, editors. Comprehensive textbook of psychiatry. 6th ed. Baltimore (MD): Williams and Wilkins, 1995: 539Google Scholar
  2. 2.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994Google Scholar
  3. 3.
    Nurnberg HG. An overview of somatic treatment of psychosis during pregnancy and postpartum. Gen Hosp Psychiatry 1989 Sep: 11(5): 328–38PubMedCrossRefGoogle Scholar
  4. 4.
    Glaze R, Chapman G, Murray D. Recurrence of psychosis during late pregnancy. Br J Psychiatry 1991 Oct; 159: 567–9PubMedCrossRefGoogle Scholar
  5. 5.
    McEwen BS, Parsons B. Gonadal steroid action on the brain: neurochemistry and neuropharmacology. Ann Rev Pharmacol Toxicol 1982; 22: 555–98CrossRefGoogle Scholar
  6. 6.
    Altshuler LL, Szuba MR, Course of psychiatric disorders in pregnancy. Neurol Clin 1994 Aug; 12(3): 613–35PubMedGoogle Scholar
  7. 7.
    Carpenter WT, Hanlon TE, Heinrichs DW, et al. Continuous versus targeted medication in schizophrenic outpatients: outcome results. Am J Psychiatry 1990 Jun; 147(9): 1138–48PubMedGoogle Scholar
  8. 8.
    Kendell RE, Chalmers JC, Platz C. Epidemiology of puerperal psychoses. Br J Psychiatry 1987 May; 150: 662–73PubMedCrossRefGoogle Scholar
  9. 9.
    McNeil TF, Kaij L, Malmquist-Larsson A. Women with nonorganic psychosis: factors associated with pregnancy’s effect on mental health during pregnancy. Acta Psychiatr Scand 1984 Sep; 70(3): 140–8PubMedCrossRefGoogle Scholar
  10. 10.
    Grunebaum HU, Abernathy VD, Rotman ES, et al. The family planning attitudes, practices, and motivation of mental patients. Am J Psychiatry 1971 Dec; 128(6): 740–4PubMedGoogle Scholar
  11. 11.
    Wisner KL, Peindl K, Hanusa BH. Symptomatology of affective and psychotic illnesses related to childbearing. J Affect Disord 1994 Feb; 30(2): 77–87PubMedCrossRefGoogle Scholar
  12. 12.
    Pozzo EED, Marsh FH. Psychosis and pregnancy: some new ethical and legal dilemmas for the physician. Am J Obstet Gynecol 1987 Feb; 156(2): 425–7Google Scholar
  13. 13.
    Miller LJ. Sexuality, reproduction and family planning in women with schizophrenia. Schizophr Bull 1997; 23(4): 623–35PubMedCrossRefGoogle Scholar
  14. 14.
    Calabrese JR, Gulledge AD. Psychotropics during pregnancy and lactation: a review. Psychosomatics 1985; 26(5): 413–26PubMedCrossRefGoogle Scholar
  15. 15.
    Rudolph B, Larson GL, Sweeny S, et al. Hospitalized pregnant psychotic women: characteristics and treatment issues. Hosp Community Psychiatry 1990 Feb 6; 41(2): 159–63PubMedGoogle Scholar
  16. 16.
    Casiano ME, Hawkins DR. Major mental illness and child bearing: a role for the consultation-liaison psychiatrist in obstetrics. Psychiatric Clin North Am 1987 Mar; 10(1): 35–51Google Scholar
  17. 17.
    Mortola JF. The use of psychotropic agents in pregnancy and lactation. Psychiatr Clin North Am 1989 Mar; 12(1): 69–87PubMedGoogle Scholar
  18. 18.
    Janicak PG, Davis JM, Preskorn SH, et al., editors. Principles and practice of psychopharmacotherapy. Baltimore (MD): Williams and Wilkins, 1993: 93–184, 481-4Google Scholar
  19. 19.
    Heinonen OP, Slone D, Shapiro S. Birth defects and drug in pregnancy. Littleton (MA): Publishing Sciences Group, 1977Google Scholar
  20. 20.
    Golbe LI. Parkinson’s disease and pregnancy. Neurology 1987 Jul; 37(7): 1245–9PubMedCrossRefGoogle Scholar
  21. 21.
    Rosa F. Amantidine pregnancy experience [letter]. Reprod Toxicol 1994; 8: 531PubMedCrossRefGoogle Scholar
  22. 22.
    Sherer DM, D’Amico ML, Warshal DP, et al. Recurrent mild abruptio placentae occurring immediately after repeated electroconvulsive therapy in pregnancy. Am J Obstet Gynecol 1991 Sep; 165(3): 652–3PubMedGoogle Scholar
  23. 23.
    Repke JT, Berger NG. Electroconvulsive therapy in pregnancy. Obstet Gynecol 1984 Mar; 63(3 Suppl.): 39s–41sPubMedGoogle Scholar
  24. 24.
    Sobel DE. Fetal damage due to ECT, insulin coma, chlorpromazine or reserpine. Arch Gen Psychiatry 1960; 2: 606–11CrossRefGoogle Scholar
  25. 25.
    Miller LJ. Use of electroconvulsive therapy during pregnancy. Hosp Commun Psychiatry 1994 May; 45(5): 444–50Google Scholar
  26. 26.
    Walker R, Swartz CM. Electroconvulsive therapy during high-risk pregnancy. Gen Hosp Psychiatry 1994 Sep; 16(5): 348–353PubMedCrossRefGoogle Scholar
  27. 27.
    Green TP, O’Dea RF, Mikin BL. Determinants of drug disposition and effects in fetus. Ann Rev Pharmacol Toxicol 1979; 19: 285–322CrossRefGoogle Scholar
  28. 28.
    Edlund MJ, Craig TJ. Antipsychotic drug use and birth defects: An epidemiologic reassessment. Compr Psychiatry 1984 Jan-Feb; 25(1): 32–7PubMedCrossRefGoogle Scholar
  29. 29.
    Guze BH, Guze PA. Psychotropic medication use during pregnancy. West J Med 1989 Sep; 151(3): 296–8PubMedGoogle Scholar
  30. 30.
    Cohen LS. Psychotropic drug use in pregnancy. Hosp Commun Psychiatry 1989 Jun; 40(6): 566–7Google Scholar
  31. 31.
    Cohen LS, Heller VL, Rosenbaum JF. Treatment guidelines for psychotropic drug use in pregnancy. Psychosomatics 1989 Win; 30(1): 25–33PubMedCrossRefGoogle Scholar
  32. 32.
    Van Waes A, Van De Velde E. Safety evaluation of haloperidol in the treatment of hyperemesis gravidarum. J Clin Pharmacol 1969 Jul-Aug; 9: 224–7CrossRefGoogle Scholar
  33. 33.
    Hill RM, Stern L. Drugs in pregnancy: effects on the fetus and newborn. Drugs 1979 Mar; 17(3): 182–97PubMedCrossRefGoogle Scholar
  34. 34.
    Milkovich L, Van Den Berg BJ. An evaluation of the teratogenicity of certain antinauseant drugs. Am J Obstet Gynecol 1976; 125: 244–8PubMedGoogle Scholar
  35. 35.
    Slone D, Siskind V, Heinonen O, et al. Antenatal exposure to phenothiazines in relation to congenital malformations, perinatal mortality rate, birth weight, and intelligence quotient score. Am J Obstet Gynecol 1977 Jul; 128(5): 486–8PubMedGoogle Scholar
  36. 36.
    Rumeau-Rouqette C, Goujard J, Huel G. Possible teratogenic effects of phenothiazine in human beings. Teratology 1977 Feb; 15(1): 57–64CrossRefGoogle Scholar
  37. 37.
    Altshuler LL, Cohen L, Szuba MP, et al. Psychopharmacologic management of psychiatric illness during pregnancy: dilemmas and guidelines. Am J Psychiatry 1996 May; 153(5) 592–606PubMedGoogle Scholar
  38. 38.
    Pinkofsky HB, Fitz-Gerald MJ, Reeves RR. Psychotropic treatment during pregnancy [letter]. Am J Psychiatry 1977; 154(5): 718–9Google Scholar
  39. 39.
    Kopelman AE, McCullar FW, Heggeness L. Limb malformation following maternal use of haloperidol. JAMA 1975 Jan 6; 231(1): 62–4CrossRefGoogle Scholar
  40. 40.
    Dieulangard P, Coignet J, Vical JC. Sur un cas d’ecto phocomelia, peut etre d’origine medicamenteuse. Bull Fed Gynecol Obstet 1966; 18: 85–7Google Scholar
  41. 41.
    Hanson JW, Oakley GP. Haloperidol and limb deformity [letter]. JAMA 1975 Jan 6; 231(1): 26PubMedCrossRefGoogle Scholar
  42. 42.
    Ananth J. Congenital malformations with psychopharmacologic agents. Compr Psychiatry 1975 Sep-Oct; 16(5): 598–600CrossRefGoogle Scholar
  43. 43.
    Moriarity AJ, Nance MR. Trifluoperazine and pregnancy [letter]. Can Med Assoc J 1963; 88: 375–6Google Scholar
  44. 44.
    Bracken MB, Holford TR. Exposure to prescribed drugs in pregnancy and association with congenital malformations. Obstet Gynecol 1981; 58: 336–44PubMedGoogle Scholar
  45. 45.
    Sobel DE. Infant mortality and malformations in children of schizophrenic women. Psychiatr Q 1961; 35: 60–4CrossRefGoogle Scholar
  46. 46.
    Rieder RO, Rosenthal D, Wender P, et al. The offspring of schizophrenics, fetal and neonatal deaths. Arch Gen Psychiatry 1975 Feb; 32(2): 200–11PubMedCrossRefGoogle Scholar
  47. 47.
    Wrede G, Mednick SA, Huttunen MO, et al. Pregnancy and delivery complications in births of an unselected series of Finnish children with schizophrenic mothers. Acta Psychiatr Scand 1980 Oct; 62(4): 369–81PubMedCrossRefGoogle Scholar
  48. 48.
    Sacker A, Done DJ, Crow TJ. Obstetric complications in children born to parents with schizophrenia: a metanalysis of case-control studies. Psychol Med 1996 Mar; 26(2): 279–87PubMedCrossRefGoogle Scholar
  49. 49.
    Walker E, Emory E. Infants at risk for psychopathology: offspring of schizophrenic parents. Child Dev 1983 Oct; 54(5): 1269–85PubMedCrossRefGoogle Scholar
  50. 50.
    Nurnberg HG, Prudic J. Guidelines for treatment of psychosis during pregnancy. Hosp Commun Psychiatry 1984 Jan; 35(1): 67–71Google Scholar
  51. 51.
    Hill RM, Desmond MM, Kay JL. Extrapyramidal dysfunction in an infant of a schizophrenic mother. J Pediatr 1966 Oct; 69(4): 589–95PubMedCrossRefGoogle Scholar
  52. 52.
    O’Connor M, Johnson GH, James DI. Intrauterine effect of phenothiazines. Med J Aust 1981 Apr; 1(8): 416–7PubMedGoogle Scholar
  53. 53.
    Cleary MR Fluphenazine decanoate during pregnancy. Am J Psychiatry 1977 Jul; 134(7): 815–6PubMedGoogle Scholar
  54. 54.
    Levy W, Wisniewski K. Chlorpromazine causing extrapyramidal dysfunction. N Y State J Med 1974 Apr; 74(4): 684–5PubMedGoogle Scholar
  55. 55.
    Tamer A, McKey R, Arias D, et al. Phenothiazine-induced extrapyramidal dysfunction in the neonate. J Pediatr 1969 Sep; 75(3): 479–80PubMedCrossRefGoogle Scholar
  56. 56.
    Auerbach JG, Hans SL, Marcus J, et al. Maternal psychotropic medication and neonatal behavior. Neurotoxicol Teratol 1992; 14(6): 399–406PubMedCrossRefGoogle Scholar
  57. 57.
    Falterman CG, Richardson CJ. Small left colon syndrome associated with maternal ingestion of psychotropic drugs. J Pediatr 1980 Aug; 97(2): 308–10PubMedCrossRefGoogle Scholar
  58. 58.
    Scokel P, Jones WN. Infant jaundice after phenothiazines. Obstet Gynecol 1962; 20: 124–7PubMedCrossRefGoogle Scholar
  59. 59.
    Kris E. Children of mothers maintained on pharmacotherapy during pregnancy and postpartum. Curr Ther Res Clin Exp 1965; 7: 785–9PubMedGoogle Scholar
  60. 60.
    Ayd FJ. Children born to mothers treated with chlorpromazine during pregnancy. Clin Med 1964; 71: 1748–63Google Scholar
  61. 61.
    Clarke CV, Gorman D, Vernadakis A. Effects of prenatal administration of psychotropic drugs on behavior of developing rats. Dev Psychobiol 1970; 3(4): 225–35CrossRefGoogle Scholar
  62. 62.
    Spear LP, Shalaby IA, Brach J. Chronic administration of haloperidol during development: behavioral and psychopharmacological effects. Psychopharmacology (Berl) 1980; 70(1): 47–58CrossRefGoogle Scholar
  63. 63.
    Robertson RT, Majka JA, Peter CP, et al. Effects of prenatal exposure to chlorpromazine on postnatal development and behavior of rats. Toxicol Appl Pharmacol 1980 May; 52(3): 541–9CrossRefGoogle Scholar
  64. 64.
    Cunningham FG, MacDonald PC, Gant NF, et al., editors. Williams obstetrics. 19th ed. Norwalk (CT): Appleton and Lange, 1993: 225–30Google Scholar
  65. 65.
    Baldessarini RG. Drugs and the treatment of psychiatric disorders. In: Hardman JG, Limbird LE, Molinoff PG, et al., editors. Goodman and Gillman’s the pharmacologic basis of therapeutics. 9th ed. New York: McGraw-Hill, 1996: 399–430Google Scholar
  66. 66.
    Gelenberg AJ. Psychosis. In: Gelenberg AJ, Bassuk EL, Schoonover SC, editors. The practitioner’s guide to psychoactive drugs. 3rd ed. New York: Plenum Press, 1991: 125–78Google Scholar
  67. 67.
    Pinkofsky HB. Psychosis during pregnancy: treatment considerations. Ann Clin Psychiatry 1997 Sep; 9(3): 175–9PubMedGoogle Scholar
  68. 68.
    Waldman MD, Satterman AZ. Pregnancy and clozapine. Am J Psychiatry 1993 Jan; 150(1): 168–9PubMedGoogle Scholar
  69. 69.
    Barnas C, Bergnat A, Hummer M, et al. Clozapine concentrations in maternal and fetal plasma, amniotic fluid, and breast milk [letter]. Am J Psychiatry 1994 Jun; 151(6): 944Google Scholar
  70. 70.
    Jann MW. Clozapine. Pharmacotherapy 1991; 11(3): 179–95PubMedGoogle Scholar
  71. 71.
    Dickson RA, Dawson DT. Olanzapine and pregnancy. Can J Psychiatry 1998 Mar; 43: 196–7PubMedGoogle Scholar
  72. 72.
    Kuller JA, Katz VL, McMahon ML, et al. Pharmacologic treatment of psychiatric disease in pregnancy and lactation: fetal and neonatal effects. Obstet Gynecol 1996 May; 87 (5 Pt 1): 789–94PubMedCrossRefGoogle Scholar
  73. 73.
    Boobis AR, Lewis P. Drugs in pregnancy. Altered pharmacokinetics. Br J Hosp Med 1982 Dec; 28(6): 566–73PubMedGoogle Scholar
  74. 74.
    Goldberg HL, Nissim R. Psychotropic drugs in pregnancy and lactation. Int J Psychiatry 1994; 24(2): 129–49CrossRefGoogle Scholar
  75. 75.
    Viguera AC, Baldassarini RC. Neuroleptic withdrawal in schizophrenic patients. Arch Gen Psychiatry 1995 Mar; 52(3): 189–92PubMedCrossRefGoogle Scholar
  76. 76.
    Decker S, Malm U, Lepp M. Schizophrenic relapse after drug withdrawal is predictable. Acta Psychiatr Scand 1986 Feb; 73(2): 181–5CrossRefGoogle Scholar

Copyright information

© Adis International Limited 2000

Authors and Affiliations

  1. 1.Department of PsychiatryLouisiana State University Medical CenterShreveportUSA

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