Can I Take Antipsychotic Medications While I’m Pregnant?

Imagine taking a medication that helps improve a mental health condition: Life moves on, and you’re ready to begin your next chapter with having a baby. But would it be safe to continue this medication during pregnancy? Could this medication be harmful to your unborn baby?

About 2% of U.S. adults take antipsychotic medications for mental health conditions. And, over the years, there have been concerns that these medications may cause harm to unborn babies. But more recent research has shown these risks may not be as high as originally thought.

In this article, we’ll discuss the safety and risks of taking antipsychotic medications during pregnancy.

What are antipsychotic medications used to treat?

Antipsychotic medications treat multiple mental health conditions. They’re first-choice medications for treating schizophrenia. They’re also used for other mental health conditions, including:

• Bipolar disorder

• Depression

• Tourette syndrome

Antipsychotics work by balancing dopamine — a chemical messenger — in the brain. Newer antipsychotics, called atypical antipsychotics, also balance serotonin levels. This can help improve mood, memory, and thinking.

Is it safe to take antipsychotics while I’m pregnant?

Research suggests that many atypical antipsychotics can be safely used during pregnancy. But it’s still important to speak with your healthcare provider. They’ll weigh the risks and benefits of these medications with you.

The National Pregnancy Registry for Atypical Antipsychotics studies the safety of these medications. Pregnancy exposure registries are research databases. They collect information about women who took medication during pregnancy. This helps healthcare providers and pregnant women learn about medication safety during pregnancy.

The registry for atypical antipsychotics recently published some of their study’s results. As of April 2020, just under 900 pregnant women reported taking one of these medications.

Of the women taking antipsychotics, about 2% had babies born with major birth defects. This was similar to women who didn’t take antipsychotics. This showed that the overall risk of major birth defects was about the same for both groups.

What are the risks of taking antipsychotics while pregnant?

If you become pregnant while taking an antipsychotic, notify your healthcare provider right away. They’ll discuss the risks and benefits of continuing these medications during pregnancy. Here, we’ll discuss a few of those risks and what current research shows.

Birth defects

People fear that taking antipsychotics during pregnancy can harm their unborn babies. But, as mentioned above, pregnancy exposure registries haven’t found these medications to raise the risk of birth defects.

A large study of over 1 million pregnant women also found no significant difference in the number of major birth defects. Researchers then broke it down by individual medications. They noticed different risks among antipsychotics.

Risperidone (Risperdal) had a slightly higher risk of birth defects than other antipsychotics. Researchers need further studies to determine how big the risk really is.

Developmental concerns

Developmental complications are another concern for those taking antipsychotics. These complications include being on the autism spectrum or showing signs of attention deficit-hyperactivity disorder (ADHD).

In a large study, over 15,000 children were exposed to antipsychotics before birth. But compared to children not exposed during pregnancy, there was no greater risk of being on the autism spectrum or developing ADHD.

Gestational diabetes

Gestational diabetes is a type of diabetes that happens during pregnancy. There are concerns that antipsychotics may raise the risk for this condition. This is because antipsychotics can raise the risk for developing Type 2 diabetes in the general population.

But a review of multiple studies didn’t identify a link between taking antipsychotics during pregnancy and developing gestational diabetes. Still, discuss potential metabolism side effects of antipsychotics with your healthcare provider.

Should I stop my antipsychotics while I’m pregnant?

Stopping medication during pregnancy isn’t the right option for everyone. It can cause your condition to worsen or symptoms to return. Talk with your healthcare provider first before stopping your antipsychotic.

Even if you and your healthcare provider decide to stop your medication, you’ll want to make sure your mental health doesn’t suffer. Untreated mental health conditions during pregnancy can raise your risk of complications. This includes preterm labor (giving birth too early).

Your healthcare provider may recommend some of the following non-medication therapies:

• Cognitive behavioral therapy (CBT). CBT is a type of talk therapy used to treat many different mental health conditions. People who stop antipsychotic medications may benefit from attending more CBT sessions.

• Cognitive remediation. This type of therapy focuses on improving thinking processes, like attention and memory.

• Psychoeducation. This involves methods to raise people’s awareness about their mental health conditions. It also provides insight about ways to manage it.

• Coping strategies. This involves teaching positive strategies to help you overcome challenges. For example, journaling can be a helpful coping strategy.

• Family intervention. These methods aim to help encourage a strong family support network. Support from loved ones can be helpful in managing mental health conditions.

When can I start taking antipsychotics again?

If you stopped your antipsychotic during pregnancy, you may decide to restart it after your baby is born. But it’s important to know that many antipsychotic medications pass into breast milk. This means that nursing can expose newborn babies to these medications.

There’s limited information about the safety of taking antipsychotic medications while breastfeeding. Some research suggests that atypical antipsychotics may be OK to continue while nursing. Olanzapine (Zyprexa) seems to be a preferred antipsychotic for breastfeeding. This is because only a small amount passes into breastmilk.

One small study looked at about 100 women who took olanzapine while nursing. Most babies didn’t experience any problems. The most common side effects that babies experienced included:

• Sleepiness

• Irritability

• Shakiness

• Trouble sleeping

Some antipsychotic medications may be more harmful than others for breastfeeding infants. One example is clozapine (Clozaril). Infants exposed to clozapine may be at higher risk for lower numbers of white blood cells. These are the cells that fight infections. There are also concerns that aripiprazole (Abilify) may lower breast milk production.

It’s important to discuss these risks with your healthcare provider. They can help you develop a plan that fits your health needs and nursing goals.

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Written by:

Kevin Le, PharmD, BCPS, BCPPS

Kevin Le, PharmD, BCPS, BCPPS is a clinical pharmacy specialist in solid organ transplant at Ann & Robert H. Lurie Children’s Hospital of Chicago. He has been working as a pediatric pharmacist since 2016.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

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