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2. Women of Childbearing Potential
David N. Osser, MD
Associate Professor of Psychiatry
Harvard Medical School
Brockton Division of the VA Boston Healthcare System
General Editor - Psychopharmacology Algorithm Project
Harvard South Shore Residency Training Program

3. Teratogenicity and Antipsychotics

4. Teratogenicity and antipsychotic exposure
Low teratogenic risk
Study limitations
Retrospective observational studies
Gentile, S. (2010). Antipsychotic therapy during early and late pregnancy. A systematic review. Schizophrenia bulletin, 36(3),

5. Neonatal Complications

6. Neonatal effects Neonatal dyskinesia Jaundice Some FGAs Weight gain
Gestational metabolic syndromes:
diabetes
macrosomia
Some SGAs
Increased risk of neonatal seizures
Clozapine
Low birth weight and high birth weight
Hip dysplasia
Neural tube defects
Olanzapine
Neonatal effects
Collins, K. O.et al (2003). Maternal haloperidol therapy associated with dyskinesia in a newborn. American journal of health-system pharmacy, 60(21).

7. Neonatal effects Neonatal dyskinesia Jaundice Some FGAs Weight gain
Gestational metabolic syndromes:
diabetes
macrosomia
Some SGAs
Increased risk of neonatal seizures
Clozapine
Low birth weight and high birth weight
Hip dysplasia
Neural tube defects
Olanzapine
Neonatal effects
Newham, J. J., Tet al (2008). Birth weight of infants after maternal exposure to typical and atypical antipsychotics: prospective comparison study. The British Journal of Psychiatry, 192(5),
 Reis, M., & Källén, B. (2008). Maternal use of antipsychotics in early pregnancy and delivery outcome. Journal of clinical psychopharmacology, 28(3),

8. Neonatal effects Neonatal dyskinesia Jaundice Some FGAs Weight gain
Gestational metabolic syndromes:
diabetes
macrosomia
Some SGAs
Increased risk of neonatal seizures
Clozapine
Low birth weight and high birth weight
Hip dysplasia
Neural tube defects
Olanzapine
Neonatal effects
Ernst, C. L., & Goldberg, J. F. (2002). The reproductive safety profile of mood stabilizers, atypical antipsychotics, and broad-spectrum psychotropics. Journal of Clinical Psychiatry, 63(Suppl 4), 42-55

9. Neonatal effects Neonatal dyskinesia Jaundice Some FGAs Weight gain
Gestational metabolic syndromes:
diabetes
macrosomia
Some SGAs
Increased risk of neonatal seizures
Clozapine
Low birth weight and high birth weight
Hip dysplasia
Neural tube defects
Olanzapine
Neonatal effects
Spyropoulou, A. C.,et al  (2006). Hip dysplasia following a case of olanzapine exposed pregnancy: a questionable association. Archives of women's mental health, 9(4),
Arora, M., & Praharaj, S. K. (2006). Meningocele and ankyloblepharon following in utero exposure to olanzapine. European psychiatry, 21(5),

10. Effect of underlying conditions Confounding by indication
The problem with observational studies

11. Recommendations

12. If possible, try to avoid all drugs in the first trimester.
If not, try to use the lowest effective dose, and use as few different drugs as possible
Adjust doses as pregnancy progresses
Blood volume expands 30% in third trimester
Plasma level monitoring may be useful
Avoid anticholinergics, except for short-term need
Avoid depot antipsychotics; infants may show EPS for several months
FGAs may be preferred over SGAs in pregnancy
This is currently changing

13. If possible, try to avoid all drugs in the first trimester.
If not, try to use the lowest effective dose, and use as few different drugs as possible
Adjust doses as pregnancy progresses
Blood volume expands 30% in third trimester
Plasma level monitoring may be useful
Avoid anticholinergics, except for short-term need
Avoid depot antipsychotics; infants may show EPS for several months
FGAs may be preferred over SGAs in pregnancy
This is currently changing

14. If possible, try to avoid all drugs in the first trimester.
If not, try to use the lowest effective dose, and use as few different drugs as possible
Adjust doses as pregnancy progresses
Blood volume expands 30% in third trimester
Plasma level monitoring may be useful
Avoid anticholinergics, except for short-term need
Avoid depot antipsychotics; infants may show EPS for several months
FGAs may be preferred over SGAs in pregnancy
This is currently changing

15. If possible, try to avoid all drugs in the first trimester.
If not, try to use the lowest effective dose, and use as few different drugs as possible
Adjust doses as pregnancy progresses
Blood volume expands 30% in third trimester
Plasma level monitoring may be useful
Avoid anticholinergics, except for short-term need
Avoid depot antipsychotics; infants may show EPS for several months
FGAs may be preferred over SGAs in pregnancy
This is currently changing

16. If possible, try to avoid all drugs in the first trimester.
If not, try to use the lowest effective dose, and use as few different drugs as possible
Adjust doses as pregnancy progresses
Blood volume expands 30% in third trimester
Plasma level monitoring may be useful
Avoid anticholinergics, except for short-term need
Avoid depot antipsychotics; infants may show EPS for several months
FGAs may be preferred over SGAs in pregnancy
This is currently changing

17. If possible, try to avoid all drugs in the first trimester.
If not, try to use the lowest effective dose, and use as few different drugs as possible
Adjust doses as pregnancy progresses
Blood volume expands 30% in third trimester
Plasma level monitoring may be useful
Avoid anticholinergics, except for short-term need
Avoid depot antipsychotics; infants may show EPS for several months
FGAs may be preferred over SGAs in pregnancy
This is currently changing

18. Next Video: Active Substance Use Disorders