Medications can pose a number of risk to a developing fetus. It is important for all possible parents to ask which medications are safe during pregnancy. This question becomes even more pressing when medications for depression, bipolar disorder, schizophrenia, or any other mental health condition come into play. Certainly, mental health medications are necessary for daily functioning, but can those medications harm a developing baby?

Antipsychotic medications are common treatments for illnesses such as bipolar disorder and schizophrenia, even though conclusive answers about whether these medications cause birth defects have been lacking.Many medications are classified as “pregnancy risk category C”, which states “There are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.”Labels may be confusing and many expectant mothers find themselves debating the use of mental health medications.

Recent Study Examines Risks

Recently, a massive study of 1.3 million pregnant women, researchers from Brigham and Women’s Hospital and Harvard Medical School concluded that, after accounting for co-existing mental and physical conditions and their associated behaviors, the risk of birth defects is not significant, with one possible exception. A drug known as risperidone (Risperdal) is one medication that has come under fire for, among other things, causing boys to grow breasts.2

“Whenever possible, medications should be avoided during pregnancy,” the authors wrote. “However, frequently avoidance is not possible, as is the case for women with schizophrenia, bipolar disorder or major depressive disorders, in which few alternative treatment options are available.”

Make no mistake – the odds of having a child with birth defects while taking antipsychotics is elevated, particularly among newer medications. Here are some of the study’s findings:

  • Among women not taking antipsychotics, 32.7 per 1,000 births were diagnosed with congenital malformations. That compares to 44.5 per 1,000 births among those taking newer (atypical) antipsychotics. The most commonly taken newer medications were quetiapine (Seroquel), ariprazole (Abilify), Risperdal, olanzapine (Zyprexa) and ziprasidone (Geodon).
  • The number of birth defects per 1,000 was slightly lower for the older-line (typical) antipsychotics, at 38.2.
  • The women taking antipsychotics during the first trimester tended to be older than the mean age of 24, were more likely to be white, had more psychiatric and neurologic conditions than others, used more medications, were in poorer health, and were more likely to deliver prematurely, according to the study.

Antipsychotic Medications During Pregnancy

Pregnant woman with mental health issuesThe authors conducted the study by analyzing data from a nationwide Medicaid database. They defined “antipsychotic use” as having filled at least one prescription during the first 90 days of pregnancy.

“Our findings suggest that use of APs (antipsychotics) early in pregnancy does not meaningfully increase the risk for congenital malformation or cardiac malformation, with the possible exception of risperidone,” the authors concluded.

The study is timely because more pregnant women are taking antipsychotics than ever before. “Exposure to antipsychotics (APs) during pregnancy is increasingly common,” the authors wrote. However, they added that “newer atypical drugs are less likely to affect fertility than the older typical antipsychotics.”

In an accompanying JAMA editorial, Dr. Katherine L. Wisner of the Northwestern University Feinberg School of Medicine, Chicago, called the research a “landmark report.”3

But it’s a difficult dilemma. “Medication use by pregnant women is increasing across time and now is nearly universal,” Wisner and co-authors wrote. “In 2008, nearly 94 percent of women took at least one medication during pregnancy. In the first trimester, 82.3 percent used at least one and 27.6 percent reported taking four or more medications. These staggering statistics highlight the public health importance of research to inform pharmacotherapy for pregnant women.”

When it comes to discontinuing medication among seriously mentally ill pregnant women, the result can be harmful to the baby as well as the mother. Women may not eat properly under circumstances of mania or depression, they may place themselves in dangerous situations due to lapses in judgment, or they may have cardiovascular events resulting from anxiety, mania, or other symptoms.

“Nowhere in medicine is the need for personalization of care so crucial than during pregnancy. Personalization of the treatment for serious mental illness with consideration of pregnancy and the mother’s capacity to provide sustenance for the growing fetus and newborn,” the editorial concluded.

Alternatives to High-Risk Medications

In a 2013 report in Current Psychiatry, the authors concluded that “quetiapine (Seroquel) is a reasonable first choice when a new atypical antipsychotic is indicated for a pregnant patient.”4 They added that any medication treatment carries some risks, so each individual mother must be assessed fully to determine all of the risks and benefits of any potential medication treatment.

It is a very good idea to consult an experienced medical team before and during pregnancy if you or a loved one takes medication for mental health issues. Each case is unique, and there is no one-size-fits-all solution.

Written by David Heitz


Bibliography

1 Content and Format of Labeling for Human Prescription Drug and Biological Products; Requirements for Pregnancy and Lactation Labeling Federal Register. Vol. 73, No. 104. 29 May 2008. Web. Accessed 3 July 2017.

2 Huybrechts, Krista et. al. Antipsychotic Use in Pregnancy and the Risk for Congenital Malformations. JAMA Psychiatry.17 August 2016. Web. Accessed 3 July 2017.

3 Wisner, Katherine L. Use of Antipsychotics During Pregnancy. JAMA Psychiatry.17 Aug. 2016. Web. Accessed 3 July 2017.

4 Atypical Antipsychotics during Pregnancy. Current Psychiatry.12 July 2013. Web. Accessed 3 July 2017.