Safety of the use of atypical antipsychotic drugs in pregnancy

For ethical reasons, it is impossible to test the safety of drugs during pregnancy. Due to the high standards of research concerning the teratogenicity of drugs and their influence on development in the prenatal and postnatal period, there is not a list of drugs that are 100% safe during pregnancy. This puts practicing physicians in a difficult position, because if they want to adhere to scientific guidelines, medicine as a science has nothing to offer to women who are treated for a mental illness such as schizophrenia and want to become pregnant or become pregnant and still want to be treated. In the treatment of schizophrenia, the risk of the disease for the mother and the fetus may exceed the risk of the treatment itself. Therefore in practice each case must be considered individually. The authors decided to review the literature, based on the available knowledge, trying to formulate guidelines for practitioners treating pregnant women diagnosed with schizophrenia.

While data based on case studies and case series, as well as from observational studies, are still fragmented, they may indicate the relative safety of second-generation antipsychotics (SGAs) in pregnancy. The teratogenicity of SGAs has not been demonstrated in women taking them in the first trimester of pregnancy; however, their use in the second and third trimesters of pregnancy increases the risk of excessive birth weight. Since SGAs differ in placental passage, drugs with a lower placental passage have a lower risk. As polypharmacy increases the potential risk of teratogenicity, it is contraindicated in pregnant women. Pregnancy may alter the metabolism of SGAs, which should be considered when determining the dose of a drug. Due to the risk of side effects in the newborn, in the third trimester of pregnancy drugs that cause extrapyramidal symptoms should be avoided. Women taking SGAs may take too little folic acid, which may increase the risk of neural tube development in the fetus.