BMJ  2004;329:933-934 (23 October), doi:10.1136/bmj.329.7472.933

Editorial

Safety of antipsychotic drugs for pregnant and breastfeeding women with non-affective psychosis

Multicentre cohort studies are needed as randomised trials are impractical

The first 150 words of the full text of this article appear below.

Around 2% of women develop a non-affective psychotic disorder, and more than half of them have children.^{1 2} Women with nonaffective psychoses are less fertile than controls, partly because of hyperprolactinaemia secondary to antipsychotic drugs.^{3 4} The use of atypical drugs such as clozapine and olanzapine, which do not have this effect, may increase fertility rates. Weighing risks against benefits in treating pregnant and breastfeeding women with antipsychotics requires assessment of clinical effectiveness versus risk of toxicity to mother, fetus, newborn, and the developing child. Withholding antipsychotic treatment may expose mother and fetus to more harm than benefit as, in addition to behavioural disturbance which may put both at risk, physiological changes associated with psychosis could affect fetoplacental integrity and development of the central nervous system. Subsequently, poor clinical outcomes for mothers may result in poorer interaction between mother and infant.⁵ But the impact of antipsychotic medication on the fetus is also . . . [Full text of this article]

Health Services Research Department, Institute of Psychiatry, London SE5 8AF (l.howard@iop.kcl.ac.uk)

(r.webb@man.ac.uk)

(kathryn.m.abel@man.ac.uk) Centre for Women's Mental Health Research, University of Manchester, Manchester M13 9PL

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