Antipsychotic Medications and Pregnancy
Most antipsychotic agents readily cross the placenta and are se-creted in breast milk to some degree (Trixler and Tenyi, 1997). There is little data to demonstrate whether prenatal exposure to antipsychotic agents is linked to spontaneous abortion, congeni-tal malformations, carcinogenesis, intrauterine growth retarda-tion, or behavioral teratogenicity (Trixler and Tenyi, 1997). It has, however, been suggested that fetal exposure over the course of pregnancy may affect development of the dopamine system (Altshuler et al., 1996). Physicians must consider the benefits of controlling psychotic symptoms during pregnancy versus the pos-sible risks to the mother and the fetus of withdrawing treatment and the risks to the fetus of continuing treatment (Trixler and Tenyi, 1997). Thus far, second-generation antipsychotics have not been shown to be teratogenic in animal studies or in preliminary human reports (Goldstein et al., 2000; Stoner et al., 1997; Trix-ler and Tenyi, 1997). However, if possible, use of antipsychotic medication should be avoided, at least during the first trimester, especially between weeks 6 and 10, unless the patient’s psychosis places the mother and/or her fetus at significant risk (Trixler and Tenyi, 1997; American Psychiatric Association, 2000). Antipsy-chotic medications may be relatively safe during the second and third trimesters of pregnancy. If a first-generation antipsychotic agent is used, high-potency agents appear to be preferable for first-line management, because they have a lower propensity to cause orthostasis (Trixler and Tenyi, 1997). Low doses should be given, administration of antipsychotic medication should be as brief as possible, and the medication should be discontinued 5 to 10 days before delivery to minimize the chances of the newborn experiencing EPS (Trixler and Tenyi, 1997; American Psychiat-ric Association, 2000). This notion, however, has been reevalu-ated (Altshuler et al., 1996), since discontinuation of medication before delivery may put the mother at risk for decompensation (Trixler and Tenyi, 1997). Anticholinergic agents should also be avoided during pregnancy, especially for the first trimester (American Psychiatric Association, 2000). Since antipsychot-ics are also secreted into breast milk, the infants should not be breast-fed if the mother resumes taking antipsychotic medication postpartum.