Contemporary antipsychotic treatment in schizophrenia patients during pregnancy

Abstract

Gestational schizophrenia reveals a major dilemma. Discontinuation of antipsychotic therapy exposes the patient to the risk of relapse, and maintenance of treatment involves possible adverse effects. Management requires a careful pharmacologic balance between maternal psychological stability and fetal safety. The study aimed to identify the antipsychotics with the most optimal risk-benefit profile in the treatment of pregnant women with schizophrenia, correlating therapeutic efficacy with perinatal safety. An analysis of data from the specialized scientific literature, from sources published in PubMed, Medscape, Cochrane Library, Web of Science, international guidelines, observational studies over the last years, was performed to obtain comparative data according to teratogenicity, placental transfer and metabolic risks. The atypical antipsychotics: olanzapine, quetiapine, aripiprazole are the most well documented and commonly used in practice. Quetiapine, with reduced placental transfer, has not been associated with major congenital malformations, but requires weight gain monitoring. Olanzapine has increased therapeutic efficacy but with significant metabolic risk. Aripiprazole recommended in moderate forms with low risk of hyperprolactinemia. Haloperidol is useful in emergencies. Clozapine is reserved for refractory cases in the context of the development of agranulocytosis. Minimally effective monotherapy is recommended under multidisciplinary supervision. Management in pregnancy aims to stabilize the mental state without compromising fetal safety. Olanzapine, quetiapine and aripiprazole are the pharmacological options of choice and the therapeutic choice should be individualized according to symptoms, comorbidities and identified risks.